Provider Demographics
NPI:1629361464
Name:NOLAN, KATHLEEN (LCSW, CCM)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:NOLAN
Suffix:
Gender:F
Credentials:LCSW, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:ROSEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60018-5318
Mailing Address - Country:US
Mailing Address - Phone:312-224-0529
Mailing Address - Fax:
Practice Address - Street 1:5600 PEARL ST
Practice Address - Street 2:
Practice Address - City:ROSEMONT
Practice Address - State:IL
Practice Address - Zip Code:60018-5318
Practice Address - Country:US
Practice Address - Phone:312-224-0529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2025-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0205111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical