Healthcare Provider Details

I. General information

NPI: 1447561881
Provider Name (Legal Business Name): CHMELA FLUENCY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 OLD MCHENRY RD UNIT 1R
LONG GROVE IL
60047-8858
US

IV. Provider business mailing address

146 OLD MCHENRY RD UNIT 1R
LONG GROVE IL
60047-8858
US

V. Phone/Fax

Practice location:
  • Phone: 847-293-2571
  • Fax:
Mailing address:
  • Phone: 847-293-2571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146003373
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number146003373
License Number StateIL

VIII. Authorized Official

Name: MRS. KRISTIN A. CHMELA
Title or Position: OWNER/DIRECTOR
Credential: M.A. CCC-SLP
Phone: 847-293-2571