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General NPI Number Information
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NPI Number | 1316582703
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Entity Type | Individual
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Provider Name | KALEIGH ELLA DENEAL MS, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 11/09/2019
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Last Update Date | 11/09/2019
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Provider Practice Location Address
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Address Line | 792 N MAIN ST
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City | ANNA
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State | IL
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Zip | 62906-1627
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Country | US
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Telephone | 618-833-6302
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Fax |
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Provider Business Mailing Address
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Address Line | 1212 S LEDFORD ST
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City | HARRISBURG
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State | IL
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Zip | 62946-3154
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Country | US
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Telephone | 618-771-7800
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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 | 146014524
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License Number State | IL
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