Provider Demographics
NPI:1124873716
Name:ABRAHAMSEN, KASEY MARY (SLP)
Entity type:Individual
Prefix:MISS
First Name:KASEY
Middle Name:MARY
Last Name:ABRAHAMSEN
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 1:21328 PRESTANCIA DR
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8402
Mailing Address - Country:US
Mailing Address - Phone:708-557-5273
Mailing Address - Fax:
Practice Address - Street 1:18 N CATHERINE AVE
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-5930
Practice Address - Country:US
Practice Address - Phone:708-482-9453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146017641235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist