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General NPI Number Information
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NPI Number | 1811032139
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Entity Type | Individual
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Provider Name | MS. NICOLE ALLEN BURROUGHS
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Gender | Female
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 08/09/2011
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Provider Practice Location Address
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Address Line | 1507 E 53RD ST UNIT 703
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City | CHICAGO
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State | IL
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Zip | 60615-4573
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Country | US
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Telephone | 312-485-1589
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Fax |
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Provider Business Mailing Address
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Address Line | 1507 E 53RD ST UNIT 703
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City | CHICAGO
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State | IL
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Zip | 60615-4573
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Country | US
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Telephone | 312-485-1589
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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 | 146.007227
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 22003586A
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License Number State | IN
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