Healthcare Provider Details

I. General information

NPI: 1144590639
Provider Name (Legal Business Name): MS. RHONDA E. GUMBEL-THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2011
Last Update Date: 12/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4503 S OAKENWALD AVE
CHICAGO IL
60653-4513
US

IV. Provider business mailing address

4503 S OAKENWALD AVE
CHICAGO IL
60653-4513
US

V. Phone/Fax

Practice location:
  • Phone: 773-398-9023
  • Fax:
Mailing address:
  • Phone: 773-285-2494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146.002549
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: