Provider Demographics
NPI:1710298534
Name:SCUDDER, KATHERINE ESTELLE (MS, CF-SLP)
Entity Type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:ESTELLE
Last Name:SCUDDER
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14904 S HAWTHORN CIR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-2106
Mailing Address - Country:US
Mailing Address - Phone:815-436-2717
Mailing Address - Fax:
Practice Address - Street 1:857 CENTER CT
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:IL
Practice Address - Zip Code:60404-8519
Practice Address - Country:US
Practice Address - Phone:815-730-1818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.001550235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist