Provider Demographics
NPI:1437478112
Name:DEVEREUX, KELLY KATHLEEN (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:KATHLEEN
Last Name:DEVEREUX
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:17820 HARPER RD
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-2139
Mailing Address - Country:US
Mailing Address - Phone:708-444-7002
Mailing Address - Fax:
Practice Address - Street 1:19100 CRESCENT DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-7510
Practice Address - Country:US
Practice Address - Phone:708-478-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146005676235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363594409OtherKIDS CAN DO