Kelly A. Holverson, M.S., CCC-SLP
Individual provider Active NPI Speech-Language Pathologist · Beach Park, IL
NPI 1467735209 · NPPES record last updated Sep 27, 2011
Key facts
- NPI
- 1467735209
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 146010105 (IL)
- Practice address
- 38286 N Geraghty Ave
Beach Park, IL 60087-1748 - Phone
- (847) 404-5411
- NPI assigned
- Sep 27, 2011
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 146010105 | IL | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 146010105 | IL | Yes |
Addresses
Primary practice location
38286 N Geraghty Ave
Beach Park, IL 60087-1748
Mailing address
38286 N Geraghty Ave
Beach Park, IL 60087-1748
Other providers in Beach Park, IL
- Mary Sol Enriquez
- Diana Evelyn Gallardo
- Grishma V. Gandhi
- Golden Star Healthcare Inc
- Jennifer Lynn Heuschmidt
- Robert Benjamin Hudson Sr.
- Tayseer Ahmed Ibrahim
- Kelly M Ingram
- Roberta Jeter
- Amal Khaled
All providers in Beach Park, IL · Speech-Language Pathologist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 27, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.