Provider Demographics
NPI:1679893879
Name:PARDIKES, KRISTINE KAY (CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:KAY
Last Name:PARDIKES
Suffix:
Gender:F
Credentials:CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12811 S 82ND CT
Mailing Address - Street 2:
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464-2020
Mailing Address - Country:US
Mailing Address - Phone:708-448-2424
Mailing Address - Fax:
Practice Address - Street 1:12811 S 82ND CT
Practice Address - Street 2:
Practice Address - City:PALOS PARK
Practice Address - State:IL
Practice Address - Zip Code:60464-2020
Practice Address - Country:US
Practice Address - Phone:708-448-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.008294235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist