Provider Demographics
NPI:1225541154
Name:KHALIL, JUSTINE VIDA
Entity Type:Individual
Prefix:MRS
First Name:JUSTINE
Middle Name:VIDA
Last Name:KHALIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JUSTINE
Other - Middle Name:VIDA
Other - Last Name:STUKAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:145 S YORK ST UNIT 426
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-3469
Mailing Address - Country:US
Mailing Address - Phone:630-297-5308
Mailing Address - Fax:
Practice Address - Street 1:305 N VAN NORTWICK AVE
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-1711
Practice Address - Country:US
Practice Address - Phone:630-937-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist