Provider Demographics
NPI:1104175330
Name:DESALVO, KATHRYN ANNE (SLP)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:ANNE
Last Name:DESALVO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13160 W VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-8700
Mailing Address - Country:US
Mailing Address - Phone:773-485-1314
Mailing Address - Fax:
Practice Address - Street 1:13160 W VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-8700
Practice Address - Country:US
Practice Address - Phone:773-485-1314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.002401235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist