Provider Demographics
NPI:1548815905
Name:BOYNE, KATHARYN MICHAEL
Entity type:Individual
Prefix:
First Name:KATHARYN
Middle Name:MICHAEL
Last Name:BOYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHARYN
Other - Middle Name:MICHAEL
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27001 W CYPRESS RD
Mailing Address - Street 2:
Mailing Address - City:CHANNAHON
Mailing Address - State:IL
Mailing Address - Zip Code:60410-3423
Mailing Address - Country:US
Mailing Address - Phone:719-505-6323
Mailing Address - Fax:
Practice Address - Street 1:15900 W 127TH ST STE 201
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-2912
Practice Address - Country:US
Practice Address - Phone:630-281-2496
Practice Address - Fax:630-839-9138
Is Sole Proprietor?:No
Enumeration Date:2019-08-02
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL104100000X
ILRBT-19-91484106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician