Provider Demographics
NPI:1376080788
Name:KELLY, NATALIE (MA, CCC-SLP/L)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:MA, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2437 W IRVING PARK RD APT 2E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-2496
Mailing Address - Country:US
Mailing Address - Phone:815-403-9299
Mailing Address - Fax:
Practice Address - Street 1:2437 W IRVING PARK RD APT 2E
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-2496
Practice Address - Country:US
Practice Address - Phone:815-403-9299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-23
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.013564235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist