1124635974 NPI number — KATHLEEN GEN O'LEARY MS. CCC-SLP/L

Table of content: KATHLEEN GEN O'LEARY MS. CCC-SLP/L (NPI 1124635974)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124635974 NPI number — KATHLEEN GEN O'LEARY MS. CCC-SLP/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'LEARY
Provider First Name:
KATHLEEN
Provider Middle Name:
GEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS. CCC-SLP/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124635974
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9106 S 50TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAK LAWN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60453-1710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-368-0869
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11053 S MILLARD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60655-3327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-329-4535
Provider Business Practice Location Address Fax Number:
708-368-0869
Provider Enumeration Date:
09/25/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 146018283 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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