Healthcare Provider Details

I. General information

NPI: 1801702717
Provider Name (Legal Business Name): KATHERINE CLARE THERIAULT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 LEGACY CIR
NAPERVILLE IL
60563-1257
US

IV. Provider business mailing address

1516 LEGACY CIR STE 100
NAPERVILLE IL
60563-1253
US

V. Phone/Fax

Practice location:
  • Phone: 331-213-6626
  • Fax:
Mailing address:
  • Phone: 331-249-6626
  • Fax: 331-213-7989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number242.019131
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: