Provider Demographics
NPI:1114049558
Name:CHMELA, KRISTIN A (MA, CCC-SLP, BRFS)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:A
Last Name:CHMELA
Suffix:
Gender:F
Credentials:MA, CCC-SLP, BRFS
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:ARCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:136 GLEN RD
Mailing Address - Street 2:
Mailing Address - City:HAWTHORN WOODS
Mailing Address - State:IL
Mailing Address - Zip Code:60047-9211
Mailing Address - Country:US
Mailing Address - Phone:847-540-6160
Mailing Address - Fax:
Practice Address - Street 1:4160 IL ROUTE 83
Practice Address - Street 2:SUITE 101
Practice Address - City:LONG GROVE
Practice Address - State:IL
Practice Address - Zip Code:60047-5083
Practice Address - Country:US
Practice Address - Phone:847-821-1237
Practice Address - Fax:847-276-2743
Is Sole Proprietor?:No
Enumeration Date:2007-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist