| Doctor Name: | MISS KATHRYN MARIE BIENEMANN |
| NPI Number: | 1295887362 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, NCC, LCPC |
| License Number: | 180-005588 |
| Business Practice Address: | 2418 W Sherman Ave West Peoria, IL - 616045460 |
| Business Phone Number: | 3092191912 |
| Business Fax Number: | |
| Mailing Address: | 2418 W Sherman Ave, WEST PEORIA |
| State: | IL |
| Postal Code: | 616045460 |
| Phone Number: | 3092191912 |
| Fax Number: | |
| NPI Enumeration Date: | 01/17/2007 |
| NPI Last Update Date: | 07/25/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 180-005588 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |