Provider Demographics
NPI:1538216007
Name:KEDZIERSKI, CARYN ALISON (MA, CCC-A)
Entity type:Individual
Prefix:MRS
First Name:CARYN
Middle Name:ALISON
Last Name:KEDZIERSKI
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CHERRY HILL CR
Mailing Address - Street 2:
Mailing Address - City:HAWTHORN WOODS
Mailing Address - State:IL
Mailing Address - Zip Code:60047-9220
Mailing Address - Country:US
Mailing Address - Phone:847-438-2899
Mailing Address - Fax:
Practice Address - Street 1:1880 WINCHESTER ROAD
Practice Address - Street 2:SUITE 103
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3940
Practice Address - Country:US
Practice Address - Phone:847-816-1116
Practice Address - Fax:847-438-2633
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147-000396231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL84457Medicare UPIN