Provider Demographics
NPI:1629670237
Name:SHEERAN, KATHLEEN ALEXANDRA (AUD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ALEXANDRA
Last Name:SHEERAN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9669 KENTON AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1226
Mailing Address - Country:US
Mailing Address - Phone:847-504-3300
Mailing Address - Fax:847-504-3305
Practice Address - Street 1:9669 KENTON AVE STE 206
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1226
Practice Address - Country:US
Practice Address - Phone:847-504-3300
Practice Address - Fax:847-504-3305
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002741A237600000X
IL147001775231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter