Healthcare Provider Details

I. General information

NPI: 1619510492
Provider Name (Legal Business Name): RYAN MINOGUE MS, CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2019
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 E NORTHWEST HWY
PALATINE IL
60067-8183
US

IV. Provider business mailing address

3043 N SOUTHPORT AVE
CHICAGO IL
60657-4229
US

V. Phone/Fax

Practice location:
  • Phone: 847-604-0955
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146014205
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: