Basic Information
| Provider Information | |||||||||
| NPI: | 1831383579 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHERRY DEMARCO | ||||||||
| FirstName: | KENDRA | ||||||||
| MiddleName: | DANIELLE | ||||||||
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| Credential: | MA, CCC-SLP/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21000 S FRANKFORT SQUARE RD STE D | ||||||||
| Address2: | |||||||||
| City: | FRANKFORT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604239386 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8154691500 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 21000 S FRANKFORT SQUARE RD STE D | ||||||||
| Address2: | |||||||||
| City: | FRANKFORT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604239386 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8154691500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2007 | ||||||||
| LastUpdateDate: | 02/07/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 146009141 | IL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.