Provider Demographics
NPI:1942978457
Name:MARRO, KAITLYN LOUISE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:LOUISE
Last Name:MARRO
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 N SANDBURG TER UNIT 1104
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-8272
Mailing Address - Country:US
Mailing Address - Phone:631-891-7004
Mailing Address - Fax:
Practice Address - Street 1:7423 MADISON ST
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130-1502
Practice Address - Country:US
Practice Address - Phone:847-909-1490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
IL146016499235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist