Healthcare Provider Details

I. General information

NPI: 1821163015
Provider Name (Legal Business Name): RACHEL LESLIE POTTER MHS CCC SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RACHEL LESLIE DEKOVEN MHS CCC SLP

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N CHILDRENS PLZ BOX 142
CHICAGO IL
60614-3363
US

IV. Provider business mailing address

5228 SUFFIELD TER
SKOKIE IL
60077-1565
US

V. Phone/Fax

Practice location:
  • Phone: 773-327-0680
  • Fax: 773-327-0547
Mailing address:
  • Phone: 847-213-0423
  • Fax: 847-213-0433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: