Provider Demographics
NPI:1245494988
Name:CARNEY, KATIE EILEEN (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:KATIE
Middle Name:EILEEN
Last Name:CARNEY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10332 LAVERGNE AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-4711
Mailing Address - Country:US
Mailing Address - Phone:773-914-2194
Mailing Address - Fax:773-360-5813
Practice Address - Street 1:10332 LAVERGNE AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4711
Practice Address - Country:US
Practice Address - Phone:773-914-2194
Practice Address - Fax:773-360-5813
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146009754235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist