Provider Demographics
NPI:1568696722
Name:PHILO, KIMBERLY ANNE (CCC-SLP/C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANNE
Last Name:PHILO
Suffix:
Gender:F
Credentials:CCC-SLP/C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 ASBURY DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-9019
Mailing Address - Country:US
Mailing Address - Phone:630-236-8744
Mailing Address - Fax:
Practice Address - Street 1:1025 ASBURY DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-9019
Practice Address - Country:US
Practice Address - Phone:630-236-8744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-03
Last Update Date:2009-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.007602235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist