Provider Demographics
NPI:1780947564
Name:TOLSMA, KALEENA C (SLP)
Entity type:Individual
Prefix:MRS
First Name:KALEENA
Middle Name:C
Last Name:TOLSMA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 BIESTER DR
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008-4016
Mailing Address - Country:US
Mailing Address - Phone:815-543-7817
Mailing Address - Fax:
Practice Address - Street 1:8989 BELOIT RD
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-1714
Practice Address - Country:US
Practice Address - Phone:815-547-5244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.010267235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist