Kelly Nicole Banaszak
Individual provider Active NPI Speech-Language Pathologist · Park Forest, IL
NPI 1891550604 · NPPES record last updated Oct 24, 2024
Key facts
- NPI
- 1891550604
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 242.007647 (IL)
- Practice address
- 242 S Orchard Dr
Park Forest, IL 60466-2041 - Phone
- (940) 070-8668
- NPI assigned
- Feb 20, 2024
- 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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 242.007647 | IL | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 242.007647 | IL | Yes |
Addresses
Primary practice location
242 S Orchard Dr
Park Forest, IL 60466-2041
Mailing address
5470 Natalie Dr
Oak Forest, IL 60452-2128
Phone (708) 738-0198
Other names
- Ms. Kelly Nicole O'Connor
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All providers in Park Forest, 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 Oct 24, 2024. 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.