Provider Demographics
NPI:1154756443
Name:WILKIE, KATHERINE M (MS, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:M
Last Name:WILKIE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 HARRISON ST # 2
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-1349
Mailing Address - Country:US
Mailing Address - Phone:708-305-2176
Mailing Address - Fax:
Practice Address - Street 1:640 HARRISON ST # 2
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-1349
Practice Address - Country:US
Practice Address - Phone:708-305-2176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146011712235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist