Provider Demographics
NPI:1285917898
Name:WALDVOGEL, KELLY CHRISTINE (AUD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:CHRISTINE
Last Name:WALDVOGEL
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 1:30 E HURON ST APT 2502
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4704
Mailing Address - Country:US
Mailing Address - Phone:708-870-7163
Mailing Address - Fax:
Practice Address - Street 1:908 N ELM ST
Practice Address - Street 2:STE 306
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3635
Practice Address - Country:US
Practice Address - Phone:630-323-5256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147001407231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist