Healthcare Provider Details

I. General information

NPI: 1871100966
Provider Name (Legal Business Name): KATHRYN CICHON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 W DUNDEE RD
BUFFALO GROVE IL
60089-3704
US

IV. Provider business mailing address

703 S CAN DOTA AVE
MOUNT PROSPECT IL
60056-3601
US

V. Phone/Fax

Practice location:
  • Phone: 847-777-8995
  • Fax:
Mailing address:
  • Phone: 847-253-7297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number242.006129
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: