=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528522471
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATE GALINOVSKIY MS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2019
-----------------------------------------------------
Last Update Date | 01/24/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25807 N DIAMOND LAKE RD
-----------------------------------------------------
City | MUNDELEIN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60060-9415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-566-6601
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 710 OLD HUNT RD
-----------------------------------------------------
City | FOX RIVER GROVE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60021-1838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-452-2934
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------