Provider Demographics
NPI:1932116118
Name:BERNARD, KATHRYN ANN (MA, CCC-SLP L)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANN
Last Name:BERNARD
Suffix:
Gender:F
Credentials:MA, 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 1:217 E CULLERTON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-1306
Mailing Address - Country:US
Mailing Address - Phone:312-922-0820
Mailing Address - Fax:312-922-0804
Practice Address - Street 1:217 E CULLERTON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-1306
Practice Address - Country:US
Practice Address - Phone:312-922-0820
Practice Address - Fax:312-922-0804
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
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