Provider Demographics
NPI:1083129613
Name:JOHNSON, KATHLEEN YEZEK (MS/CCC/SLP-L)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:YEZEK
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS/CCC/SLP-L
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:ANNE
Other - Last Name:YEZEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4700 SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:RINGWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60072-9606
Mailing Address - Country:US
Mailing Address - Phone:815-728-0459
Mailing Address - Fax:
Practice Address - Street 1:4700 SCHOOL RD
Practice Address - Street 2:
Practice Address - City:RINGWOOD
Practice Address - State:IL
Practice Address - Zip Code:60072-9606
Practice Address - Country:US
Practice Address - Phone:815-728-0459
Practice Address - Fax:815-728-0459
Is Sole Proprietor?:No
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.004009235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist