Healthcare Provider Details

I. General information

NPI: 1306019096
Provider Name (Legal Business Name): KMK CONSULTING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 07/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3290 JULIE LN
MONTGOMERY IL
60538-3368
US

IV. Provider business mailing address

3290 JULIE LN
MONTGOMERY IL
60538-3368
US

V. Phone/Fax

Practice location:
  • Phone: 773-677-4925
  • Fax:
Mailing address:
  • Phone: 773-677-4925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146008464
License Number StateIL

VIII. Authorized Official

Name: MRS. KATHRYN M KUNKEL
Title or Position: PRESIDENT
Credential: M.S., CCC-SLP, BCBA
Phone: 773-677-4925