Provider Demographics
NPI:1750739769
Name:HENSELER, KELLI
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:HENSELER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 W MADISON ST
Mailing Address - Street 2:UNIT 1009
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-3369
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:901 W MADISON ST
Practice Address - Street 2:UNIT 1009
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-3369
Practice Address - Country:US
Practice Address - Phone:630-853-7456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146013084235Z00000X
OHSP.12093235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist