Healthcare Provider Details

I. General information

NPI: 1386589117
Provider Name (Legal Business Name): CATHERINE ANN LEDESMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

742 S POPLAR AVE
KANKAKEE IL
60901-5550
US

IV. Provider business mailing address

249 S SCHUYLER AVE
KANKAKEE IL
60901-3884
US

V. Phone/Fax

Practice location:
  • Phone: 815-295-0397
  • Fax:
Mailing address:
  • Phone: 815-262-8397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: