Provider Demographics
NPI:1003258476
Name:RUTHERFORD, KAY (SLPA)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5028 N SPRINGFIELD AVE
Mailing Address - Street 2:3W
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3194
Mailing Address - Country:US
Mailing Address - Phone:773-267-4692
Mailing Address - Fax:
Practice Address - Street 1:5028 N SPRINGFIELD AVE
Practice Address - Street 2:3W
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3194
Practice Address - Country:US
Practice Address - Phone:773-267-4692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2170002922355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant