Provider Demographics
NPI:1245565183
Name:SERAFIN, KATHLEEN THERESE (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:THERESE
Last Name:SERAFIN
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12312 S 75TH AVE
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1306
Mailing Address - Country:US
Mailing Address - Phone:773-636-3865
Mailing Address - Fax:
Practice Address - Street 1:12312 S 75TH AVE
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1306
Practice Address - Country:US
Practice Address - Phone:773-636-3865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-09
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14-000-0000-002355S0801X
IL1-13-14442103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant