Healthcare Provider Details

I. General information

NPI: 1639851736
Provider Name (Legal Business Name): KELLSEY O'ROURKE CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13400 S ROUTE 59 STE 116-326
PLAINFIELD IL
60585-5826
US

IV. Provider business mailing address

PO BOX 47949
CHICAGO IL
60647-7218
US

V. Phone/Fax

Practice location:
  • Phone: 815-267-7334
  • Fax: 630-429-9411
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146.017974
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: