Provider Demographics
NPI:1811610751
Name:KLINE, JOANN I
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:I
Last Name:KLINE
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 1:45W729 JERICHO RD
Mailing Address - Street 2:
Mailing Address - City:BIG ROCK
Mailing Address - State:IL
Mailing Address - Zip Code:60511-9782
Mailing Address - Country:US
Mailing Address - Phone:630-908-0222
Mailing Address - Fax:
Practice Address - Street 1:1001 E WILSON ST STE 100
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-3157
Practice Address - Country:US
Practice Address - Phone:630-761-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.002779235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist