Provider Demographics
NPI:1568975043
Name:KERENDIAN, PHYLLIS (MAT, CCC)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:KERENDIAN
Suffix:
Gender:F
Credentials:MAT, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 W KENSINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-1112
Mailing Address - Country:US
Mailing Address - Phone:847-718-5582
Mailing Address - Fax:
Practice Address - Street 1:801 W KENSINGTON RD
Practice Address - Street 2:
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-1112
Practice Address - Country:US
Practice Address - Phone:847-718-5582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist