Provider Demographics
NPI:1578035044
Name:SURBECK, KATHRYN SILVIS (SPEECH-LANGUAGE PATH)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:SILVIS
Last Name:SURBECK
Suffix:
Gender:F
Credentials:SPEECH-LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:125 S WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-1877
Mailing Address - Country:US
Mailing Address - Phone:217-479-4287
Mailing Address - Fax:217-479-4313
Practice Address - Street 1:125 S WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-1877
Practice Address - Country:US
Practice Address - Phone:217-479-4287
Practice Address - Fax:217-479-4313
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.002267235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist