Healthcare Provider Details

I. General information

NPI: 1124635974
Provider Name (Legal Business Name): KATHLEEN GEN O'LEARY MS. CCC-SLP/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11053 S MILLARD AVE
CHICAGO IL
60655-3327
US

IV. Provider business mailing address

9106 S 50TH AVE
OAK LAWN IL
60453-1710
US

V. Phone/Fax

Practice location:
  • Phone: 888-329-4535
  • Fax: 708-368-0869
Mailing address:
  • Phone: 708-368-0869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146018283
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: