Provider Demographics
NPI:1144077967
Name:KENNEDY, LISA B (MS,CCC-SLP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:B
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:B
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17623 66TH CT
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-4021
Mailing Address - Country:US
Mailing Address - Phone:708-712-5132
Mailing Address - Fax:
Practice Address - Street 1:10501 EMILIE LN
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-8805
Practice Address - Country:US
Practice Address - Phone:708-326-2402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.004997235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist