Provider Demographics
NPI:1043675713
Name:HAYWOOD, KATRINA
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:HAYWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:582 HOLIDAY LN
Mailing Address - Street 2:
Mailing Address - City:HAINESVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-4700
Mailing Address - Country:US
Mailing Address - Phone:735-585-7387
Mailing Address - Fax:
Practice Address - Street 1:3010 GRAND AVE
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-2321
Practice Address - Country:US
Practice Address - Phone:847-377-8296
Practice Address - Fax:847-984-5689
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-23
Last Update Date:2024-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490266651041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical