Healthcare Provider Details

I. General information

NPI: 1558292516
Provider Name (Legal Business Name): GENTLE GIANT THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3126 W WALTON ST UNIT 2
CHICAGO IL
60622-1288
US

IV. Provider business mailing address

3126 W WALTON ST UNIT 2
CHICAGO IL
60622-1288
US

V. Phone/Fax

Practice location:
  • Phone: 708-369-7169
  • Fax:
Mailing address:
  • Phone: 708-369-7169
  • 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: MAXWEL DOMAN
Title or Position: OWNER/MANAGER
Credential: MS CCC-SLP
Phone: 708-369-7169