Provider Demographics
NPI:1437816840
Name:KT THERAPY, PLLC
Entity Type:Organization
Organization Name:KT THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KAITLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:815-685-1208
Mailing Address - Street 1:7105 VIRGINIA RD STE 17
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-7986
Mailing Address - Country:US
Mailing Address - Phone:815-201-1558
Mailing Address - Fax:815-605-0541
Practice Address - Street 1:7105 VIRGINIA RD STE 17
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7986
Practice Address - Country:US
Practice Address - Phone:815-201-1558
Practice Address - Fax:815-605-0541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-19
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty