Provider Demographics
NPI:1235759374
Name:PROKOP, KATHERINE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:PROKOP
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 SPRINGWOOD DR UNIT A2
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-1999
Mailing Address - Country:US
Mailing Address - Phone:847-370-3908
Mailing Address - Fax:
Practice Address - Street 1:7001 W CULLOM AVE
Practice Address - Street 2:
Practice Address - City:NORRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60706-7100
Practice Address - Country:US
Practice Address - Phone:708-457-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-18
Last Update Date:2020-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146013957235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist