Provider Demographics
NPI:1447443544
Name:HARMON, KREN KATHLEEN (LCSW)
Entity type:Individual
Prefix:MS
First Name:KREN
Middle Name:KATHLEEN
Last Name:HARMON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WOOD RIVER
Mailing Address - State:IL
Mailing Address - Zip Code:62095-4055
Mailing Address - Country:US
Mailing Address - Phone:618-251-0045
Mailing Address - Fax:636-695-4554
Practice Address - Street 1:7220 N LINDBERGH BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-2019
Practice Address - Country:US
Practice Address - Phone:636-695-4554
Practice Address - Fax:636-695-3099
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0066041041C0700X
MO20110047781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL215868Medicare PIN