Provider Demographics
NPI:1841760329
Name:BRAUER, KALLI R (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KALLI
Middle Name:R
Last Name:BRAUER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KALLI
Other - Middle Name:R
Other - Last Name:MONESTERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1839 W WABANSIA AVE APT 1F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-1339
Mailing Address - Country:US
Mailing Address - Phone:630-651-2180
Mailing Address - Fax:
Practice Address - Street 1:1340 N BURNING BUSH LN
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-1854
Practice Address - Country:US
Practice Address - Phone:224-612-7560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146011598235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL968773Medicaid