Provider Demographics
NPI:1902927254
Name:SKOLI, KATHLEEN A (DN)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:A
Last Name:SKOLI
Suffix:
Gender:F
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 E GRAND AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FOX LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60020-1428
Mailing Address - Country:US
Mailing Address - Phone:847-973-9050
Mailing Address - Fax:847-973-9051
Practice Address - Street 1:62 E GRAND AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:FOX LAKE
Practice Address - State:IL
Practice Address - Zip Code:60020-1428
Practice Address - Country:US
Practice Address - Phone:847-973-9050
Practice Address - Fax:847-973-9051
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001625439OtherBC BS