Healthcare Provider Details

I. General information

NPI: 1144541616
Provider Name (Legal Business Name): AILEEN LYSAUGHT M.S. CCC-SLP/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 N CATHERINE AVE
LA GRANGE IL
60525-5930
US

IV. Provider business mailing address

18 N CATHERINE AVE
LA GRANGE IL
60525-5930
US

V. Phone/Fax

Practice location:
  • Phone: 708-482-9453
  • Fax: 708-482-9454
Mailing address:
  • Phone: 708-482-9453
  • Fax: 708-482-9454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number141010739
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: