Provider Demographics
NPI:1972740348
Name:HOLMAN, KATHLEEN (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:HOLMAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 DIXON CT
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3177
Mailing Address - Country:US
Mailing Address - Phone:847-668-5406
Mailing Address - Fax:847-367-7424
Practice Address - Street 1:633 DIXON CT
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3177
Practice Address - Country:US
Practice Address - Phone:847-668-5406
Practice Address - Fax:847-367-7424
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.010112235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist