Provider Demographics
NPI:1609168582
Name:CROFT, KATHRYN ELENA (M S, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:ELENA
Last Name:CROFT
Suffix:
Gender:F
Credentials:M S, CCC-SLP
Other - Prefix:MRS
Other - First Name:KATHIE
Other - Middle Name:ELENA
Other - Last Name:CROFT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:M S, CCC-SLP
Mailing Address - Street 1:25839 S WOODRUSH WAY
Mailing Address - Street 2:
Mailing Address - City:CHANNAHON
Mailing Address - State:IL
Mailing Address - Zip Code:60410-8773
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25839 S WOODRUSH WAY
Practice Address - Street 2:
Practice Address - City:CHANNAHON
Practice Address - State:IL
Practice Address - Zip Code:60410-8773
Practice Address - Country:US
Practice Address - Phone:815-467-5003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.006343235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist