Provider Demographics
NPI:1164683124
Name:KELCH, KRISTINE
Entity type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:
Last Name:KELCH
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 1:412 E ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4630
Mailing Address - Country:US
Mailing Address - Phone:630-833-4327
Mailing Address - Fax:630-833-4328
Practice Address - Street 1:412 E ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4630
Practice Address - Country:US
Practice Address - Phone:630-833-4327
Practice Address - Fax:630-833-4328
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146008442235Z00000X
IL3556237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist