Healthcare Provider Details

I. General information

NPI: 1134178528
Provider Name (Legal Business Name): CELESTE R KOBULNICKY MS, CCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 11/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4255 WESTBROOK DR SUITE 208
AURORA IL
60504-8125
US

IV. Provider business mailing address

4255 WESTBROOK DR SUITE 208
AURORA IL
60504-8125
US

V. Phone/Fax

Practice location:
  • Phone: 630-898-2823
  • Fax: 630-898-8423
Mailing address:
  • Phone: 630-898-2823
  • Fax: 630-898-8423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146.000184
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: