Active NPI
Kelly Wallner
- Speech-Language Pathologist
- Park Ridge, IL
National Provider Identifier
1780296053
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 146.016037
- Practice address
- 1001 S Fairview Ave
Park Ridge, IL 60068-4712 - Phone
- (847) 318-4235
- NPI assigned
- Aug 18, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 146.016037 | IL | Primary |
Addresses
Primary practice location
1001 S Fairview Ave
Park Ridge, IL 60068-4712
Mailing address
3424 Hollywood Ave
Brookfield, IL 60513-1702
Phone (708) 250-9181
Other practice location 1
550 W Saint Charles Rd
Elmhurst, IL 60126-3038
Phone (815) 469-1500
Other practice location 2
18 N Catherine Ave
LA Grange, IL 60525-5930
Phone (708) 482-9453
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 146.016037 | IL | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Westside Childrens Therapy | Speech-Language Pathologist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597708800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679788800000",
"number": "1780296053",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3424 HOLLYWOOD AVE",
"city": "BROOKFIELD",
"state": "IL",
"postal_code": "605131702",
"telephone_number": "708-250-9181"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 S FAIRVIEW AVE",
"city": "PARK RIDGE",
"state": "IL",
"postal_code": "600684712",
"telephone_number": "847-318-4235"
}
],
"practiceLocations": [
{
"address_1": "550 W Saint Charles Rd",
"address_purpose": "LOCATION",
"city": "Elmhurst",
"state": "IL",
"postal_code": "601263038",
"country_code": "US",
"telephone_number": "815-469-1500",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "18 N Catherine Ave",
"address_purpose": "LOCATION",
"city": "LA Grange",
"state": "IL",
"postal_code": "605255930",
"country_code": "US",
"telephone_number": "708-482-9453",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WALLNER",
"first_name": "KELLY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-08-18",
"last_updated": "2023-03-26",
"certification_date": "2023-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "146.016037",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Park Ridge, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.