Provider Demographics
NPI:1114248036
Name:CISZON, KATELYN P (SLP/L)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:P
Last Name:CISZON
Suffix:
Gender:F
Credentials:SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 E TERRA COTTA AVE
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-3602
Mailing Address - Country:US
Mailing Address - Phone:847-766-0011
Mailing Address - Fax:847-999-6722
Practice Address - Street 1:407 E TERRA COTTA AVE STE E
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3602
Practice Address - Country:US
Practice Address - Phone:847-766-0011
Practice Address - Fax:847-999-6722
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242001525235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist