Provider Demographics
NPI:1073078127
Name:KRILICH, GINA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:KRILICH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4741 151ST ST APT 103
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-2424
Mailing Address - Country:US
Mailing Address - Phone:708-704-8479
Mailing Address - Fax:
Practice Address - Street 1:4741 151ST ST APT 103
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-2424
Practice Address - Country:US
Practice Address - Phone:708-704-8479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.014160235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist