Healthcare Provider Details

I. General information

NPI: 1982508610
Provider Name (Legal Business Name): SEONA THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2749 GRAND AVE
WAUKEGAN IL
60085-2406
US

IV. Provider business mailing address

9345 NASHVILLE AVE
MORTON GROVE IL
60053-1325
US

V. Phone/Fax

Practice location:
  • Phone: 224-207-8567
  • Fax:
Mailing address:
  • Phone: 224-436-7335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14561266
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: