Healthcare Provider Details

I. General information

NPI: 1336391754
Provider Name (Legal Business Name): CHARLEYNE CAWN CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 ACADEMY DR
NORTHBROOK IL
60062-2421
US

IV. Provider business mailing address

650 ACADEMY DR
NORTHBROOK IL
60062-2421
US

V. Phone/Fax

Practice location:
  • Phone: 847-480-8890
  • Fax: 847-480-8897
Mailing address:
  • Phone: 847-480-8890
  • Fax: 847-480-8897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146000051
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: