Provider Demographics
NPI:1689181315
Name:JURGILANIS, KRISTEN (CCC/SLP-L)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:JURGILANIS
Suffix:
Gender:F
Credentials: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 1:1817 STERCHI DR
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-3019
Mailing Address - Country:US
Mailing Address - Phone:618-395-8540
Mailing Address - Fax:
Practice Address - Street 1:1001 N HOLLY RD
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450-4463
Practice Address - Country:US
Practice Address - Phone:618-395-8540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146004972235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist