Healthcare Provider Details

I. General information

NPI: 1548125925
Provider Name (Legal Business Name): KYLEE KINSELLA HESS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E WASHINGTON ST
BLOOMINGTON IL
61701-4364
US

IV. Provider business mailing address

PO BOX 53
WAYNESVILLE IL
61778-0053
US

V. Phone/Fax

Practice location:
  • Phone: 309-661-6275
  • Fax:
Mailing address:
  • Phone: 309-661-6275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146017685
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: