Provider Demographics
NPI:1922130624
Name:KAUP, KIMBERLY LYN (MSCCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:LYN
Last Name:KAUP
Suffix:
Gender:F
Credentials:MSCCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6220 N OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-2106
Mailing Address - Country:US
Mailing Address - Phone:773-631-7244
Mailing Address - Fax:
Practice Address - Street 1:6776 N NORTHWEST HWY
Practice Address - Street 2:UNIT 1C GROW AND LEARN SPEECH THERAPY SERVICES INC
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-1346
Practice Address - Country:US
Practice Address - Phone:773-792-8442
Practice Address - Fax:773-792-8442
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist