Healthcare Provider Details

I. General information

NPI: 1750644910
Provider Name (Legal Business Name): MARILYN CATHERINE DEUTMEYER M.S. CCC-SLP/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6020 151ST ST
OAK FOREST IL
60452-1841
US

IV. Provider business mailing address

12206 S 74TH AVE
PALOS HEIGHTS IL
60463-1339
US

V. Phone/Fax

Practice location:
  • Phone: 708-687-0900
  • Fax:
Mailing address:
  • Phone: 708-699-4109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146011565
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: