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NPI Code Detail

MEDICARE: KATHERINE PROKOP CCC-SLP

MEDICARE:   KATHERINE  PROKOP  CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist146013957IL

General Provider Information

NPI Number : 1235759374
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE PROKOP CCC-SLP
Provider Business Mailing Address
First Line : 1303 SPRINGWOOD DR UNIT A2
Second Line :
City : SCHAUMBURG
State : IL
Zip : 60193-1999
Country : US
Telephone Number : 847-370-3908
Fax Number :
Provider Business Practice Location Address
First Line : 7001 W CULLOM AVE
Second Line :
City : NORRIDGE
State : IL
Zip : 60706-7100
Country : US
Telephone Number : 708-457-0700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2020
Last Update Date : 04/19/2020

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Directions to “ KATHERINE PROKOP CCC-SLP” Practice Location

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