Provider Demographics
NPI:1942419205
Name:LUTGEN, KATHLEEN M (CCC-SP)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:M
Last Name:LUTGEN
Suffix:
Gender:F
Credentials:CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 STAUNTON RD
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-2608
Mailing Address - Country:US
Mailing Address - Phone:630-369-4584
Mailing Address - Fax:630-718-1877
Practice Address - Street 1:513 STAUNTON RD
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-2608
Practice Address - Country:US
Practice Address - Phone:630-369-4584
Practice Address - Fax:630-718-1877
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146004432235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist