Healthcare Provider Details

I. General information

NPI: 1659545028
Provider Name (Legal Business Name): KIMBERLY M CAVITT AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 W NORWOOD ST
CHICAGO IL
60660-2404
US

IV. Provider business mailing address

1420 W NORWOOD ST
CHICAGO IL
60660-2404
US

V. Phone/Fax

Practice location:
  • Phone: 773-743-3458
  • Fax:
Mailing address:
  • Phone: 773-743-3458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberA00848
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: