Provider Demographics
NPI:1063543999
Name:EHRLICH, KATHLEEN SNYDER (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:SNYDER
Last Name:EHRLICH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 DAVID ST
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-5205
Mailing Address - Country:US
Mailing Address - Phone:847-658-0634
Mailing Address - Fax:
Practice Address - Street 1:634 DAVID ST
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-5205
Practice Address - Country:US
Practice Address - Phone:847-658-0634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05627963Medicare UPIN