Provider Demographics
NPI:1871392753
Name:GARRARD, KACY
Entity type:Individual
Prefix:
First Name:KACY
Middle Name:
Last Name:GARRARD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2219 E LINNHILL LN
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61571-1908
Mailing Address - Country:US
Mailing Address - Phone:309-232-9483
Mailing Address - Fax:
Practice Address - Street 1:24468 E OAK PARK RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:IL
Practice Address - Zip Code:61520-8957
Practice Address - Country:US
Practice Address - Phone:309-232-9483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-12
Last Update Date:2025-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0246811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical