Provider Demographics
NPI:1487086716
Name:TOLLEY, KAYLEE JO (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:JO
Last Name:TOLLEY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:557 W FULLERTON PKWY UNIT G
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-6426
Mailing Address - Country:US
Mailing Address - Phone:660-619-5754
Mailing Address - Fax:
Practice Address - Street 1:5669 N NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-6153
Practice Address - Country:US
Practice Address - Phone:773-467-5669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.011805235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist