Provider Demographics
NPI:1609754902
Name:SMITH, KATHERINE LOUISE
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LOUISE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948-1216
Mailing Address - Country:US
Mailing Address - Phone:618-201-6649
Mailing Address - Fax:
Practice Address - Street 1:101 E DEYOUNG ST STE B
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-3143
Practice Address - Country:US
Practice Address - Phone:618-693-9139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker