Provider Demographics
NPI:1134178528
Name:KOBULNICKY, CELESTE R (MS, CCC/SLP)
Entity type:Individual
Prefix:
First Name:CELESTE
Middle Name:R
Last Name:KOBULNICKY
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4255 WESTBROOK DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-8125
Mailing Address - Country:US
Mailing Address - Phone:630-898-2823
Mailing Address - Fax:630-898-8423
Practice Address - Street 1:4255 WESTBROOK DR
Practice Address - Street 2:SUITE 208
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-8125
Practice Address - Country:US
Practice Address - Phone:630-898-2823
Practice Address - Fax:630-898-8423
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.000184235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL045-00662OtherBCBS-IL ID