Provider Demographics
NPI:1447561881
Name:CHMELA FLUENCY CENTER, INC.
Entity Type:Organization
Organization Name:CHMELA FLUENCY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHMELA
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:847-293-2571
Mailing Address - Street 1:146 OLD MCHENRY RD
Mailing Address - Street 2:UNIT 1R
Mailing Address - City:LONG GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60047-8858
Mailing Address - Country:US
Mailing Address - Phone:847-293-2571
Mailing Address - Fax:
Practice Address - Street 1:146 OLD MCHENRY RD
Practice Address - Street 2:UNIT 1R
Practice Address - City:LONG GROVE
Practice Address - State:IL
Practice Address - Zip Code:60047-8858
Practice Address - Country:US
Practice Address - Phone:847-293-2571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146003373235Z00000X, 305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No305R00000XManaged Care OrganizationsPreferred Provider OrganizationGroup - Single Specialty