Provider Demographics
NPI:1497134647
Name:SWEENEY, KATHLEEN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 W WELLINGTON AVE
Mailing Address - Street 2:APT 1803
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6911
Mailing Address - Country:US
Mailing Address - Phone:630-308-1164
Mailing Address - Fax:
Practice Address - Street 1:336 W. WELLINGTON AVE
Practice Address - Street 2:APT 1803
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6911
Practice Address - Country:US
Practice Address - Phone:630-308-1164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-20
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.012888235Z00000X
IA078450235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist