Provider Demographics
NPI:1366860355
Name:MAK, KATHLEEN
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:MAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 W BITTERSWEET PL # 2W
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2307
Mailing Address - Country:US
Mailing Address - Phone:630-981-4479
Mailing Address - Fax:312-878-7112
Practice Address - Street 1:657 W BITTERSWEET PL # 2W
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2307
Practice Address - Country:US
Practice Address - Phone:630-981-4473
Practice Address - Fax:312-878-7112
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.012054235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist