Provider Demographics
NPI:1124635974
Name:O'LEARY, KATHLEEN GEN (MS CCC-SLP/L)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:GEN
Last Name:O'LEARY
Suffix:
Gender:
Credentials:MS CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9106 S 50TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-1710
Mailing Address - Country:US
Mailing Address - Phone:708-368-0869
Mailing Address - Fax:
Practice Address - Street 1:11053 S MILLARD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-3327
Practice Address - Country:US
Practice Address - Phone:888-329-4535
Practice Address - Fax:708-368-0869
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-25
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
IL146018283235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst