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Doris W. Klinkhamer

Social Worker

Behavioral Health & Social Service Providers

1165 N Clark St, Suite 413, Chicago, IL 60610-2702

(312) 719-1926

PECOS Enrollment

Based on the most recent information from CMS, provider Doris W. Klinkhamer does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1386734671
Provider Type
Individual
Full Name
Klinkhamer, Doris W.
Title
Ms.
Credential
LCSW

Gender
Female
Sole Proprietor
Yes
Enumeration Date
10/15/2006
Last Updated
7/8/2007

Contact Information

Practice Location

1165 N Clark St, Suite 413, Chicago, IL 60610-2702

(312) 719-1926

Unlisted Fax

Mailing Location

4449 N California Ave, Second Floor, Chicago, IL 60625-3803

(312) 719-1926

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 1041C0700X Primary	Description Social Worker Behavioral Health & Social Service Providers	License Unlisted Issuer Illinois

Provider Identifiers

ID	Description	Issuer
ID 01633160	Description Other	Issuer BC/BS PPO PROVIDER NUMBER Illinois

Doris W. Klinkhamer

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

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