Provider Demographics
NPI:1093275935
Name:LOTTINVILLE, KENDRA MARIE
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:MARIE
Last Name:LOTTINVILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SE CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:IROQUOIS
Mailing Address - State:IL
Mailing Address - Zip Code:60945-2135
Mailing Address - Country:US
Mailing Address - Phone:815-471-5363
Mailing Address - Fax:
Practice Address - Street 1:200 E COURT ST STE 708
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3845
Practice Address - Country:US
Practice Address - Phone:815-304-5548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.015588235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist