Provider Demographics
NPI:1992013742
Name:MCDERMOTT, KARA MCCRIEF (MS)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:MCCRIEF
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 W DIVISION ST
Mailing Address - Street 2:UNIT #2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-3154
Mailing Address - Country:US
Mailing Address - Phone:817-797-0415
Mailing Address - Fax:
Practice Address - Street 1:1611 W HARRISON ST STE 530
Practice Address - Street 2:SPEECH PATHOLOGY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4861
Practice Address - Country:US
Practice Address - Phone:312-942-4947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146010346235Z00000X
GASLP006217235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist