1780702597 NPI number — KATHRYN CERNEKA SPEECH LANGUAGE PATH

Table of content: KATHRYN CERNEKA SPEECH LANGUAGE PATH (NPI 1780702597)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780702597 NPI number — KATHRYN CERNEKA SPEECH LANGUAGE PATH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CERNEKA
Provider First Name:
KATHRYN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SPEECH LANGUAGE PATH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CERNEKA
Provider Other First Name:
KATHRYN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
SPEECH LANGUAGE PATH
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1780702597
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4641 MCLAREN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OSWEGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60543-8157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-334-0766
Provider Business Mailing Address Fax Number:
855-765-7549

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4641 MCLAREN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSWEGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60543-8157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-334-0766
Provider Business Practice Location Address Fax Number:
855-765-7549
Provider Enumeration Date:
03/27/2007

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: 235Z00000X , with the licence number:  242-000377 , 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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