MRS. Kelly Nicole Banaszak
NPI #1891550604 in Park Forest, Illinois
Provider Information
- NPI Number
- 1891550604
- Entity Type
- Individual
- Name
- MRS. Kelly Nicole Banaszak
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Speech-Language Pathologist
- Enumeration Date
- Feb 20, 2024
- Last Updated
- Oct 24, 2024
Practice Location
- Address
- 242 S ORCHARD DR
- City
- Park Forest
- State
- Illinois
- ZIP Code
- 60466-2041
- Phone
- (940) 070-8668
Specialties & Taxonomy Codes
| Specialty |
|---|
| Speech-Language Pathologist |
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