Provider Demographics
NPI:1942359153
Name:LISTON, KATHLEEN S (MA, CCC-A)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:S
Last Name:LISTON
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 HICHITEE CT
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TWP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-1282
Mailing Address - Country:US
Mailing Address - Phone:847-267-8200
Mailing Address - Fax:847-267-9440
Practice Address - Street 1:775 WAUKEGAN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4342
Practice Address - Country:US
Practice Address - Phone:847-267-8200
Practice Address - Fax:847-267-9440
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA.00793231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000543958OtherANTHEM BCBS
OH2710794Medicaid
OH000000513135OtherANTHEM BCBS
OHP00376272Medicare PIN
OH2710794Medicaid
OHLI4170472Medicare PIN