Provider Demographics
NPI:1396986816
Name:CHILLEMI, KATHERINE SUMNER (MA)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:SUMNER
Last Name:CHILLEMI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10117 OAK HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:MC CORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46055-4411
Mailing Address - Country:US
Mailing Address - Phone:317-531-3952
Mailing Address - Fax:
Practice Address - Street 1:10117 OAK HAVEN DR
Practice Address - Street 2:
Practice Address - City:MC CORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46055-4411
Practice Address - Country:US
Practice Address - Phone:317-531-3952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46001930A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist