Provider Demographics
NPI:1053632943
Name:KLEGON, ILENE ZACHER (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ILENE
Middle Name:ZACHER
Last Name:KLEGON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MISS
Other - First Name:ILENE
Other - Middle Name:PATRICIA
Other - Last Name:ZACHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1049 EAST WILSON STREET
Mailing Address - Street 2:SUTITE 100
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-2478
Mailing Address - Country:US
Mailing Address - Phone:630-761-0900
Mailing Address - Fax:630-761-0909
Practice Address - Street 1:1049 E WILSON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-2474
Practice Address - Country:US
Practice Address - Phone:630-761-0900
Practice Address - Fax:630-761-0909
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-15
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.007871235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist