Provider Demographics
NPI:1285838441
Name:KENTGEN, LYNETTE (SLP)
Entity type:Individual
Prefix:MRS
First Name:LYNETTE
Middle Name:
Last Name:KENTGEN
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 1:548 S WARRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-3148
Mailing Address - Country:US
Mailing Address - Phone:847-298-2056
Mailing Address - Fax:847-298-2056
Practice Address - Street 1:548 S WARRINGTON RD
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-3148
Practice Address - Country:US
Practice Address - Phone:847-298-2056
Practice Address - Fax:847-298-2056
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist