Healthcare Provider Details

I. General information

NPI: 1104777416
Provider Name (Legal Business Name): KELLEN ANN GALLAGHER AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELLEN ANN ROGAN GALLAGHER AU.D.

II. Dates (important events)

Enumeration Date: 02/04/2026
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 W HARRISON ST STE 530
CHICAGO IL
60612-4861
US

IV. Provider business mailing address

1611 W HARRISON ST STE 530
CHICAGO IL
60612-4861
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-5332
  • Fax:
Mailing address:
  • Phone: 312-942-5332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number23002884A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147-000945
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: