Provider Demographics
NPI:1063653269
Name:OTTO, KATHRYN A (MA, CCC-A)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:A
Last Name:OTTO
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 WARRENVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-6376
Mailing Address - Country:US
Mailing Address - Phone:630-933-9999
Mailing Address - Fax:630-933-9997
Practice Address - Street 1:703 WARRENVILLE RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-6376
Practice Address - Country:US
Practice Address - Phone:630-933-9999
Practice Address - Fax:630-933-9997
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147000691231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist