Provider Demographics
NPI:1902447444
Name:FOUST ALLEN, KATHRYN RENEE (LSW)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:RENEE
Last Name:FOUST ALLEN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 HILL ST
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-5125
Mailing Address - Country:US
Mailing Address - Phone:317-446-5146
Mailing Address - Fax:
Practice Address - Street 1:241 S FRONTAGE RD STE 36
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-6169
Practice Address - Country:US
Practice Address - Phone:630-974-6777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150103381104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker