Healthcare Provider Details

I. General information

NPI: 1538216007
Provider Name (Legal Business Name): CARYN ALISON KEDZIERSKI M.A., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 WINCHESTER ROAD SUITE 103
LIBERTYVILLE IL
60048-3940
US

IV. Provider business mailing address

5 CHERRY HILL CR
HAWTHORN WOODS IL
60047-9220
US

V. Phone/Fax

Practice location:
  • Phone: 847-816-1116
  • Fax: 847-438-2633
Mailing address:
  • Phone: 847-438-2899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147-000396
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: