Healthcare Provider Details

I. General information

NPI: 1447446893
Provider Name (Legal Business Name): MARIANNE GROSS GASPARY MS-CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 05/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 W IRVING PARK RD
CHICAGO IL
60634-2459
US

IV. Provider business mailing address

6410 W IRVING PARK RD
CHICAGO IL
60634-2459
US

V. Phone/Fax

Practice location:
  • Phone: 773-736-4327
  • Fax: 773-736-4343
Mailing address:
  • Phone: 773-736-4327
  • Fax: 773-736-4343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number147.001218
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: