Provider Demographics
NPI:1073756748
Name:KALIC, VALERIE (DN)
Entity Type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:
Last Name:KALIC
Suffix:
Gender:F
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 SELBORNE RD.
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-1629
Mailing Address - Country:US
Mailing Address - Phone:708-705-7564
Mailing Address - Fax:
Practice Address - Street 1:440 SHERWOOD RD
Practice Address - Street 2:
Practice Address - City:LA GRANGE PARK
Practice Address - State:IL
Practice Address - Zip Code:60526-1968
Practice Address - Country:US
Practice Address - Phone:708-705-7564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-10
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL181-000353172P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172P00000XOther Service ProvidersNaprapath