Provider Demographics
NPI:1255058376
Name:KLINK, DORA LEIGH (AUD)
Entity type:Individual
Prefix:
First Name:DORA
Middle Name:LEIGH
Last Name:KLINK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 ELGIN AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-1654
Mailing Address - Country:US
Mailing Address - Phone:731-363-9253
Mailing Address - Fax:
Practice Address - Street 1:6905 NORTH AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1041
Practice Address - Country:US
Practice Address - Phone:708-445-7171
Practice Address - Fax:708-445-2616
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147001926231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist