Provider Demographics
NPI:1093288904
Name:KRZYSTYNIAK, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:KRZYSTYNIAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14341 S HEATHER LN
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-7820
Mailing Address - Country:US
Mailing Address - Phone:708-262-2090
Mailing Address - Fax:
Practice Address - Street 1:200 E COURT ST
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3843
Practice Address - Country:US
Practice Address - Phone:815-304-5548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
IL242.005203235Z00000X
IL146.015170235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist