Provider Demographics
NPI:1265538771
Name:KIDD, MAUREEN LANEAL
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:LANEAL
Last Name:KIDD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:
Other - Last Name:LANEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 S CASS AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-1893
Mailing Address - Country:US
Mailing Address - Phone:630-673-5023
Mailing Address - Fax:630-515-4849
Practice Address - Street 1:1 S CASS AVE
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-1893
Practice Address - Country:US
Practice Address - Phone:630-673-5023
Practice Address - Fax:630-515-4849
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146004556235Z00000X
IL146.004556235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist