Provider Demographics
NPI:1801261797
Name:KISZKOWSKI, LINDSAY (MS CCC-SLP/L)
Entity type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:
Last Name:KISZKOWSKI
Suffix:
Gender:F
Credentials:MS CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19015 S JODI RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8514
Mailing Address - Country:US
Mailing Address - Phone:708-478-1414
Mailing Address - Fax:
Practice Address - Street 1:19015 S JODI RD
Practice Address - Street 2:SUITE A
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8514
Practice Address - Country:US
Practice Address - Phone:708-478-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.012609235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist