Provider Demographics
NPI:1154645596
Name:EVANGELISTA, KATHY (MS, CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:EVANGELISTA
Suffix:
Gender:F
Credentials:MS, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 E CHICAGO AVE
Mailing Address - Street 2:SUITE 151
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-5526
Mailing Address - Country:US
Mailing Address - Phone:630-305-4196
Mailing Address - Fax:
Practice Address - Street 1:1001 E CHICAGO AVE
Practice Address - Street 2:SUITE 151
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5526
Practice Address - Country:US
Practice Address - Phone:630-305-4196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-14
Last Update Date:2010-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.006256235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist