| Doctor Name: | JORDAN LEE KELLGREN |
| NPI Number: | 1942468095 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S. CCC-SLP |
| License Number: | 001846 |
| Business Practice Address: | 1860 W Winchester Rd Ste 108 Libertyville, IL - 600485312 |
| Business Phone Number: | 8475739486 |
| Business Fax Number: | |
| Mailing Address: | 1860 W Winchester Rd Ste 108, LIBERTYVILLE |
| State: | IL |
| Postal Code: | 600485312 |
| Phone Number: | 8475739486 |
| Fax Number: | |
| NPI Enumeration Date: | 05/27/2008 |
| NPI Last Update Date: | 12/11/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 001846 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IA |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |