Provider Demographics
NPI:1447293097
Name:WEEKS, KATHRYN L (LCSW)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:L
Last Name:WEEKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:L
Other - Last Name:KOFOED-ACKERMAN-HUBBARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:15908 N GORHAM LN
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60083-9414
Mailing Address - Country:US
Mailing Address - Phone:847-395-6988
Mailing Address - Fax:847-395-6989
Practice Address - Street 1:4103 60TH ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-2509
Practice Address - Country:US
Practice Address - Phone:262-652-3000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI536-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI030452095018OtherBCBS-BILLING PROVIDER
WI42233900Medicaid
WV7069698OtherAETNA PROVIDER NUMBER
WI40968900Medicaid