Provider Demographics
NPI:1467237230
Name:EDWARDS, KATHERINE (SLP CF)
Entity Type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:SLP CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 STATE ROUTE 22 STE 216
Mailing Address - Street 2:
Mailing Address - City:FOX RIVER GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60021-1955
Mailing Address - Country:US
Mailing Address - Phone:224-219-1924
Mailing Address - Fax:
Practice Address - Street 1:960 STATE ROUTE 22 STE 216
Practice Address - Street 2:
Practice Address - City:FOX RIVER GROVE
Practice Address - State:IL
Practice Address - Zip Code:60021-1955
Practice Address - Country:US
Practice Address - Phone:224-219-1924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.007553235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist