Provider Demographics
NPI:1124450259
Name:DEGAYNER, KATHERINE DAW (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:DAW
Last Name:DEGAYNER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:JAYNE
Other - Last Name:DAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3043 PARK PL
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1140
Mailing Address - Country:US
Mailing Address - Phone:847-840-3721
Mailing Address - Fax:
Practice Address - Street 1:745 W DICKENS AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4428
Practice Address - Country:US
Practice Address - Phone:847-840-3721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242002759235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist