Most Relevant Information
Provider Data
| NPI Number: | 1003254996 |
| Provider Name: | MARY KUBALANZA |
| Entity Type: | Individual |
| Taxonomy Code: | 235Z00000X |
| Specialty: | Speech-Language Pathologist |
| License Number: | 242002571 |
Most Important Dates
| Enumeration Date: | 06/13/2013 |
| Last Updated: | 06/13/2013 |
Provider Practice Location
2001 S OAK ST
SUITE B
CHAMPAIGN
IL
618200911
Practice Location Phone/Fax
| Phone: | 2173332205 |
| Fax: |
Provider Mailing Location
401 W PENNSYLVANIA AVE
URBANA
IL
618014920
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |