Healthcare Provider Details

I. General information

NPI: 1104750314
Provider Name (Legal Business Name): GABRIELLE MARIE MASCOLO AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 S MAPLE AVE STE 3700
OAK PARK IL
60304-2806
US

IV. Provider business mailing address

430 BROOKHAVEN CIR
SUGAR GROVE IL
60554-9411
US

V. Phone/Fax

Practice location:
  • Phone: 708-660-6430
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147.012349
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: