Provider Demographics
NPI:1700264876
Name:BERZSENYI, KAITLIN AMANDA (MA)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:AMANDA
Last Name:BERZSENYI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:AMANDA
Other - Last Name:BAARCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4619 N RAVENSWOOD AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-4579
Mailing Address - Country:US
Mailing Address - Phone:773-697-7333
Mailing Address - Fax:855-502-8892
Practice Address - Street 1:4619 N RAVENSWOOD AVE STE 204
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-4579
Practice Address - Country:US
Practice Address - Phone:773-697-7333
Practice Address - Fax:855-502-8892
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-11
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24086235Z00000X
IL146.012604235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist