Provider Demographics
NPI:1609012293
Name:WILFORD, KATHRYN L (LCPC, RPT, CTC)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:L
Last Name:WILFORD
Suffix:
Gender:F
Credentials:LCPC, RPT, CTC
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:L
Other - Last Name:JAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1515 N HARLEM AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1250
Mailing Address - Country:US
Mailing Address - Phone:708-383-3405
Mailing Address - Fax:708-383-3406
Practice Address - Street 1:1515 N HARLEM AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1250
Practice Address - Country:US
Practice Address - Phone:708-383-3405
Practice Address - Fax:708-383-3406
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-02
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.005099101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional