Provider Demographics
NPI:1679092043
Name:OCHENKOWSKI, KELLI (SLP)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:OCHENKOWSKI
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11704 CHESAPEAKE DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-2537
Mailing Address - Country:US
Mailing Address - Phone:815-355-0227
Mailing Address - Fax:
Practice Address - Street 1:11704 CHESAPEAKE DR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-2537
Practice Address - Country:US
Practice Address - Phone:815-355-0227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.012760235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist