Provider Demographics
NPI:1104181684
Name:KOKALJ, KIRSTEN E
Entity Type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:E
Last Name:KOKALJ
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 1:1509 RIDGE BROOK DR
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-5348
Mailing Address - Country:US
Mailing Address - Phone:815-436-5739
Mailing Address - Fax:
Practice Address - Street 1:1509 RIDGE BROOK DR
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-5348
Practice Address - Country:US
Practice Address - Phone:815-436-5739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist