Provider Demographics
NPI:1295464543
Name:KOCON, PAULINA (AUD)
Entity type:Individual
Prefix:
First Name:PAULINA
Middle Name:
Last Name:KOCON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 N ST CLAIR ST STE 15-200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1260
Mailing Address - Country:US
Mailing Address - Phone:312-695-8182
Mailing Address - Fax:312-695-4303
Practice Address - Street 1:675 N ST CLAIR ST STE 15-200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60677-1260
Practice Address - Country:US
Practice Address - Phone:312-695-8182
Practice Address - Fax:312-695-4303
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147.001895231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist