Provider Demographics
NPI:1154831592
Name:KONDELLAS, ROSEANN
Entity Type:Individual
Prefix:MRS
First Name:ROSEANN
Middle Name:
Last Name:KONDELLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ROSEANN
Other - Middle Name:
Other - Last Name:KLIORIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18146 OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-3944
Mailing Address - Country:US
Mailing Address - Phone:708-614-4510
Mailing Address - Fax:
Practice Address - Street 1:18146 OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-3944
Practice Address - Country:US
Practice Address - Phone:708-614-4510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.007209235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist