Provider Demographics
NPI:1255842019
Name:DEBAILLIE, KELLY (MS)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:DEBAILLIE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:ORION
Mailing Address - State:IL
Mailing Address - Zip Code:61273-7757
Mailing Address - Country:US
Mailing Address - Phone:309-526-3386
Mailing Address - Fax:309-526-8864
Practice Address - Street 1:900 14TH AVE
Practice Address - Street 2:
Practice Address - City:ORION
Practice Address - State:IL
Practice Address - Zip Code:61273-7757
Practice Address - Country:US
Practice Address - Phone:309-526-3386
Practice Address - Fax:309-526-8864
Is Sole Proprietor?:No
Enumeration Date:2017-10-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146007583235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist