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General NPI Number Information
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NPI Number | 1851558647
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Entity Type | Organization
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Legal Business Name | FOX VALLEY SPEECH & SWALLOWING CENTER
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Dates
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Enumeration Date | 05/20/2008
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Last Update Date | 12/28/2011
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Provider Practice Location Address
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Address Line | 4255 WESTBROOK DR SUITE 208
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City | AURORA
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State | IL
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Zip | 60504-8125
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Country | US
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Telephone | 630-898-2823
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Fax | 630-898-8423
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Provider Business Mailing Address
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Address Line | 4255 WESTBROOK DR SUITE 208
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City | AURORA
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State | IL
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Zip | 60504-8125
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Country | US
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Telephone | 630-898-2823
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Fax | 630-898-8423
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | CELESTE R KOBULNICKY
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Credential | MS CCC
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Telephone | 630-898-2823
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | 146000184
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License Number State | IL
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