Provider Demographics
NPI:1588671952
Name:KRAMARCZYK, KELLY ELISE (MA, CCC-SLP/L)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ELISE
Last Name:KRAMARCZYK
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 1:3017 PEACHTREE CIR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-4497
Mailing Address - Country:US
Mailing Address - Phone:630-631-5820
Mailing Address - Fax:
Practice Address - Street 1:3017 PEACHTREE CIR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-4497
Practice Address - Country:US
Practice Address - Phone:630-631-5820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0002232481OtherBCBS OF IL PROVIDER NUMBE