Katharine Kuball Wagner | Chicago, IL • PECOS Search

Katharine Kuball Wagner

Social Worker

Behavioral Health & Social Service Providers

5017 W Berteau Ave, Chicago, IL 60641-1738

(630) 865-1352 (773) 680-1775

PECOS Enrollment

Based on the most recent information from CMS, provider Katharine Kuball Wagner 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 yesterday at 12:57 PM.

Profile Details

Provider ID
1598537284
Provider Type
Individual
Full Name
Wagner, Katharine Kuball
Title
Mrs.
Credential
LCSW

Gender
Female
Sole Proprietor
Yes
Enumeration Date
10/25/2023
Last Updated
10/25/2023

Contact Information

Practice Location

5017 W Berteau Ave, Chicago, IL 60641-1738

Unlisted Fax

Mailing Location

145 N Clinton Ave, Elmhurst, IL 60126-2906

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 1041C0700X Primary	Description Social Worker Behavioral Health & Social Service Providers	License 149.013121 Illinois