Healthcare Provider Details

I. General information

NPI: 1891575767
Provider Name (Legal Business Name): NICOLE DAGRES M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2023
Last Update Date: 09/29/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 E. SAINT CHARLES ROAD
ELMHURST IL
60126
US

IV. Provider business mailing address

345 E. SAINT CHARLES ROAD
ELMHURST IL
60126
US

V. Phone/Fax

Practice location:
  • Phone: 630-834-4536
  • Fax: 630-617-2384
Mailing address:
  • Phone: 630-834-4536
  • Fax: 630-617-2384

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:
Title or Position:
Credential:
Phone: