Provider Demographics
NPI:1669768321
Name:KOKORUZ, LISA E (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:E
Last Name:KOKORUZ
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 HILLSIDE LN
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60051-3657
Mailing Address - Country:US
Mailing Address - Phone:847-308-1184
Mailing Address - Fax:
Practice Address - Street 1:1800 HILLSIDE LN
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60051-3657
Practice Address - Country:US
Practice Address - Phone:847-308-1184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.005541235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist