Healthcare Provider Details

I. General information

NPI: 1972669877
Provider Name (Legal Business Name): ERIN DYCKMAN MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 12/10/2024
Certification Date:
Deactivation Date: 07/11/2012
Reactivation Date: 12/10/2024

III. Provider practice location address

2901 FINLEY RD SUITE 101
DOWNERS GROVE IL
60515-1041
US

IV. Provider business mailing address

7847 W BERWYN AVE
CHICAGO IL
60656-1605
US

V. Phone/Fax

Practice location:
  • Phone: 630-792-1800
  • Fax: 630-792-1801
Mailing address:
  • Phone: 773-301-5666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146.008117
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: