Healthcare Provider Details

I. General information

NPI: 1215597117
Provider Name (Legal Business Name): JAIME DUROS MS, CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N CLYBOURN AVE UNIT C105
CHICAGO IL
60610-2295
US

IV. Provider business mailing address

505 N MCCLURG CT APT 3501
CHICAGO IL
60611-5429
US

V. Phone/Fax

Practice location:
  • Phone: 312-242-1665
  • Fax:
Mailing address:
  • Phone: 224-567-9697
  • 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:
Title or Position:
Credential:
Phone: