Provider Demographics
NPI:1841063203
Name:LEGENSKI, CARLY ELIZABETH (AUD)
Entity type:Individual
Prefix:DR
First Name:CARLY
Middle Name:ELIZABETH
Last Name:LEGENSKI
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 1:3105 FIELDS SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-3743
Mailing Address - Country:US
Mailing Address - Phone:217-902-3277
Mailing Address - Fax:217-383-4451
Practice Address - Street 1:3105 FIELDS SOUTH DR
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-3743
Practice Address - Country:US
Practice Address - Phone:217-902-3277
Practice Address - Fax:217-383-4451
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147.001977231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist