Provider Demographics
NPI:1528618402
Name:GORNEY, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:GORNEY
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 1:7020 HERITAGE CIR UNIT 6-3B
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-5413
Mailing Address - Country:US
Mailing Address - Phone:708-953-9105
Mailing Address - Fax:
Practice Address - Street 1:7644 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-1308
Practice Address - Country:US
Practice Address - Phone:708-496-0563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2429923235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist