Healthcare Provider Details

I. General information

NPI: 1295808103
Provider Name (Legal Business Name): CHILDRENS MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/24/2008
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

2600 N HAMPDEN CT 7A
CHICAGO IL
60614-4943
US

V. Phone/Fax

Practice location:
  • Phone: 773-562-1240
  • Fax: 773-327-0547
Mailing address:
  • Phone: 773-562-1240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number146005756
License Number StateIL

VIII. Authorized Official

Name: MISS DENISE EILEEN BOGGS
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: MSCCCSLP
Phone: 773-562-1240