Individual
KATHLEEN FRANCES WALLACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
4440 W 95TH ST, OAK LAWN, IL 60453-2600
(708) 684-5580
(708) 684-4068
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
(847) 390-5900
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
1982958013
IL
363L00000X
Nurse Practitioner
277.000970
IL
363LP0200X
Pediatric Nurse Practitioner
Primary
277.000970
IL
Other
Enumeration date
05/21/2013
Last updated
02/16/2024
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