Provider Demographics
NPI:1487806873
Name:HUCK, KATHRYN PAULA
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:PAULA
Last Name:HUCK
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 1:1900 W DICKENS AVE APT 2F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3924
Mailing Address - Country:US
Mailing Address - Phone:773-386-3112
Mailing Address - Fax:
Practice Address - Street 1:1900 W DICKENS AVE APT 2F
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3924
Practice Address - Country:US
Practice Address - Phone:773-386-3112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
IL146009529235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist