Provider Demographics
NPI:1083942213
Name:ESPARZA, KELLY C (AUD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:C
Last Name:ESPARZA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 BUDD ST
Mailing Address - Street 2:
Mailing Address - City:RIVER GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60171-1735
Mailing Address - Country:US
Mailing Address - Phone:312-213-3075
Mailing Address - Fax:
Practice Address - Street 1:5835 S COTTAGE GROVE AVE
Practice Address - Street 2:DCAM 4754
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1416
Practice Address - Country:US
Practice Address - Phone:773-834-7102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147001320231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist