Healthcare Provider Details

I. General information

NPI: 1457279465
Provider Name (Legal Business Name): ABIGAIL ROSE MALCOLM M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3654 N LAKEWOOD AVE
CHICAGO IL
60613-3725
US

IV. Provider business mailing address

229 POWELL ST
CLARENDON HILLS IL
60514-1420
US

V. Phone/Fax

Practice location:
  • Phone: 773-415-1851
  • Fax: 773-755-8126
Mailing address:
  • Phone: 630-464-5988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberAM84200825A
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: