Provider Demographics
NPI:1467951905
Name:THOMPSON, KAITLIN (MS, CCC-SLP, CLC)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP, CLC
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:
Other - Last Name:BRADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-11
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146013238235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist