Provider Demographics
NPI:1285237933
Name:BIEDRON, KALEIGH ANNA (LAT, ATC)
Entity type:Individual
Prefix:
First Name:KALEIGH
Middle Name:ANNA
Last Name:BIEDRON
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6630 DAWN AVE
Mailing Address - Street 2:
Mailing Address - City:COUNTRYSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-7511
Mailing Address - Country:US
Mailing Address - Phone:630-215-6329
Mailing Address - Fax:
Practice Address - Street 1:118 S CLINTON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-3628
Practice Address - Country:US
Practice Address - Phone:312-548-8498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960046672255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer