Provider Demographics
NPI:1871895631
Name:OLDENBURG, KATHRYN (LCPC)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:
Last Name:OLDENBURG
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 N NORTH CT
Mailing Address - Street 2:SUITE 285
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-8157
Mailing Address - Country:US
Mailing Address - Phone:847-221-5622
Mailing Address - Fax:847-221-5688
Practice Address - Street 1:675 N NORTH CT
Practice Address - Street 2:SUITE 285
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-8157
Practice Address - Country:US
Practice Address - Phone:847-221-5622
Practice Address - Fax:847-221-5688
Is Sole Proprietor?:No
Enumeration Date:2010-11-30
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007639101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional