Provider Demographics
NPI:1639838097
Name:MANGAN, KATHERINE GRADY (SLP)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:GRADY
Last Name:MANGAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10245 S SEELEY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-2038
Mailing Address - Country:US
Mailing Address - Phone:773-343-9303
Mailing Address - Fax:
Practice Address - Street 1:10245 S SEELEY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-2038
Practice Address - Country:US
Practice Address - Phone:773-343-9303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.002049235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist