Provider Demographics
NPI:1316176308
Name:KITNER, BLYTHE H (AUD)
Entity type:Individual
Prefix:DR
First Name:BLYTHE
Middle Name:H
Last Name:KITNER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 SYCAMORE ROAD
Mailing Address - Street 2:NORTHERN ILLINOIS UNIVERSITY
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-9621
Mailing Address - Country:US
Mailing Address - Phone:815-753-1441
Mailing Address - Fax:
Practice Address - Street 1:3100 SYCAMORE ROAD
Practice Address - Street 2:NORTHERN ILLINOIS UNIVERSITY
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-9621
Practice Address - Country:US
Practice Address - Phone:815-753-1441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147001314231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4532303OtherBCBS