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General NPI Number Information
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NPI Number | 1841621745
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Entity Type | Organization
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Legal Business Name | THERESE MCDERMOTT-WINTER SLP LTD
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Dates
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Enumeration Date | 12/03/2013
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Last Update Date | 12/03/2013
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Provider Practice Location Address
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Address Line | 1416 W THOME AVE
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City | CHICAGO
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State | IL
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Zip | 60660-1820
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Country | US
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Telephone | 773-294-5237
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Fax | 773-754-8603
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Provider Business Mailing Address
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Address Line | 1416 W THOME AVE
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City | CHICAGO
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State | IL
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Zip | 60660-1820
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Country | US
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Telephone | 773-294-5237
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Fax | 773-754-8603
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Authorized Official
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Title or Position | OWNER
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Name | THERESE MARIE MCDERMOTT-WINTER
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Credential | MHS, CCC-SLP
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Telephone | 773-294-5237
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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 | 146-002647
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License Number State | IL
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