Individual
MRS. KATHLEEN MARY DEROCHE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
101 N VIRGINIA ST, SUITE 105, CRYSTAL LAKE, IL 60014-3426
(815) 477-4024
(815) 477-4034
Mailing address
101 N VIRGINIA ST, SUITE 105, CRYSTAL LAKE, IL 60014-3426
(815) 477-4024
(815) 477-4034
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
IL
Other
Enumeration date
07/19/2005
Last updated
08/15/2007
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