Healthcare Provider Details

I. General information

NPI: 1548007768
Provider Name (Legal Business Name): GABRIELLE PATRICIA DJUPSTROM M.S. CF SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 07/15/2024
Certification Date: 07/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3709 N KEDZIE AVE
CHICAGO IL
60618-4503
US

IV. Provider business mailing address

3709 N KEDZIE AVE
CHICAGO IL
60618-4503
US

V. Phone/Fax

Practice location:
  • Phone: 773-377-5492
  • Fax:
Mailing address:
  • Phone: 773-377-5492
  • 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: