Provider Demographics
NPI:1518481639
Name:RAINEY, KELLY ANN
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ANN
Last Name:RAINEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 SPRINGHILL DR
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-2565
Mailing Address - Country:US
Mailing Address - Phone:630-745-7547
Mailing Address - Fax:
Practice Address - Street 1:585 SPRINGHILL DR
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-2565
Practice Address - Country:US
Practice Address - Phone:630-745-7547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL217000322355S0801X
IL2170003722355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant