Provider Demographics
NPI:1942348586
Name:SLATTERY, KATHERINE B (BSED)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:B
Last Name:SLATTERY
Suffix:
Gender:F
Credentials:BSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 MALDEN AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-5844
Mailing Address - Country:US
Mailing Address - Phone:708-579-0517
Mailing Address - Fax:847-278-5434
Practice Address - Street 1:74 MALDEN AVE
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-5844
Practice Address - Country:US
Practice Address - Phone:708-579-0517
Practice Address - Fax:847-278-5434
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILKS89710698P174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist