Provider Demographics
NPI:1750419396
Name:RANKIN, KATHRYN D (MA CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:D
Last Name:RANKIN
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 1:566 DRAKE ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-2547
Mailing Address - Country:US
Mailing Address - Phone:847-845-9502
Mailing Address - Fax:847-367-8117
Practice Address - Street 1:566 DRAKE ST
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-2547
Practice Address - Country:US
Practice Address - Phone:847-845-9502
Practice Address - Fax:847-367-8117
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist