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General NPI Number Information
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NPI Number | 1316754914
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Entity Type | Individual
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Provider Name | OLIVIA MOSSIDES M.S., SLP - CCC
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Gender | Female
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Dates
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Enumeration Date | 12/17/2024
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 836 W WELLINGTON AVE STE 3809
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City | CHICAGO
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State | IL
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Zip | 60657-5147
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Country | US
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Telephone | 773-296-3066
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Fax |
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Provider Business Mailing Address
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Address Line | 345 N LA SALLE DR APT 709
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City | CHICAGO
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State | IL
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Zip | 60654-6342
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Country | US
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Telephone | 630-853-4277
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 146017384
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License Number State | IL
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