Healthcare Provider Details

I. General information

NPI: 1952872186
Provider Name (Legal Business Name): NANCY J DHOOGHE CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 WALNUT ST
PARK RIDGE IL
60068-1759
US

IV. Provider business mailing address

2121 WALNUT ST
PARK RIDGE IL
60068-1759
US

V. Phone/Fax

Practice location:
  • Phone: 847-502-4723
  • Fax:
Mailing address:
  • Phone: 847-502-4723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number381058
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: