Healthcare Provider Details

I. General information

NPI: 1275852642
Provider Name (Legal Business Name): DANIEL FREDERICK MASON CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 S ADDISON AVE
VILLA PARK IL
60181-2877
US

IV. Provider business mailing address

609 MIDWAY PARK
GLEN ELLYN IL
60137-4228
US

V. Phone/Fax

Practice location:
  • Phone: 630-620-4433
  • Fax: 630-620-1148
Mailing address:
  • Phone: 312-725-9612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP-9083-SL
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146012075
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: