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General NPI Number Information
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NPI Number | 1306567086
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Entity Type | Individual
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Provider Name | KELSEY MCILWAIN
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Gender | Female
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Dates
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Enumeration Date | 09/09/2022
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Last Update Date | 09/09/2022
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Provider Practice Location Address
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Address Line | 410 S HICKORY ST
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City | STILLMAN VALLEY
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State | IL
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Zip | 61084-8803
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Country | US
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Telephone | 815-645-2230
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Fax |
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Provider Business Mailing Address
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Address Line | 1535 STONEFIELD DR
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City | DEKALB
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State | IL
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Zip | 60115-8906
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 242.006855
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License Number State | IL
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