Healthcare Provider Details

I. General information

NPI: 1104731181
Provider Name (Legal Business Name): MARY O'BRIEN SPEECH THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2834 W HENDERSON ST
CHICAGO IL
60618-5815
US

IV. Provider business mailing address

2834 W HENDERSON ST
CHICAGO IL
60618-5815
US

V. Phone/Fax

Practice location:
  • Phone: 773-497-0115
  • Fax:
Mailing address:
  • Phone: 773-497-0115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARY O'BRIEN
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: MS, CCC-SLP/L
Phone: 773-497-0115