Provider Demographics
NPI:1386830289
Name:WASHBURN, KATHRYN JANE (MS SLP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:JANE
Last Name:WASHBURN
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 W MELROSE ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6307
Mailing Address - Country:US
Mailing Address - Phone:217-553-0110
Mailing Address - Fax:
Practice Address - Street 1:2017 W MELROSE ST UNIT 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-6307
Practice Address - Country:US
Practice Address - Phone:217-553-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.000511235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist