Provider Demographics
NPI:1871219535
Name:RODENKIRCH, KATIE A (MS, LPC, NCC)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:A
Last Name:RODENKIRCH
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 W WILSON AVE STE 5115
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5258
Mailing Address - Country:US
Mailing Address - Phone:773-570-7631
Mailing Address - Fax:
Practice Address - Street 1:1945 W WILSON AVE STE 5115
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5258
Practice Address - Country:US
Practice Address - Phone:773-570-7631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.017043101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional