Provider Demographics
NPI:1053293761
Name:MACKIN, KIERA MARIE
Entity type:Individual
Prefix:
First Name:KIERA
Middle Name:MARIE
Last Name:MACKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13133 W STONEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-8129
Mailing Address - Country:US
Mailing Address - Phone:708-738-1948
Mailing Address - Fax:
Practice Address - Street 1:10125 S ROBERTS RD STE 104
Practice Address - Street 2:
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465-1557
Practice Address - Country:US
Practice Address - Phone:708-625-5071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.008368235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist