Healthcare Provider Details

I. General information

NPI: 1114609906
Provider Name (Legal Business Name): EMELINA IDA JOHNSON MCDERMOTT AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 S CLAY ST
HINSDALE IL
60521-3257
US

IV. Provider business mailing address

PO BOX 713260
CHICAGO IL
60677-1260
US

V. Phone/Fax

Practice location:
  • Phone: 630-545-7576
  • Fax:
Mailing address:
  • Phone: 630-469-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147001963
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: