Provider Demographics
NPI:1821261074
Name:BLATTNER, KATHLEEN E (SLP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:E
Last Name:BLATTNER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:E
Other - Last Name:GANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6186 RIVER BEND DR
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-4531
Mailing Address - Country:US
Mailing Address - Phone:630-800-8760
Mailing Address - Fax:
Practice Address - Street 1:6186 RIVER BEND DR
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-4531
Practice Address - Country:US
Practice Address - Phone:630-800-8760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242000663235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist