Active NPI
Mary J Bacon, M.A., CCC-SLP
- Speech-Language Pathologist
- Chicago, IL
National Provider Identifier
1295829901
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 146.001425
- Practice address
- 1611 W Harrison St
Suite 530
Chicago, IL 60612-4861 - Phone
- (312) 942-5332
- NPI assigned
- Oct 3, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 146.001425 | IL | Primary |
Addresses
Primary practice location
1611 W Harrison St
Suite 530
Chicago, IL 60612-4861
Mailing address
131 W Adelaide St
Unit 103
Elmhurst, IL 60126-3306
Phone (708) 212-1412
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 146.001425 | IL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1424649600000",
"number": "1295829901",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "131 W ADELAIDE ST",
"address_2": "UNIT 103",
"city": "ELMHURST",
"state": "IL",
"postal_code": "601263306",
"telephone_number": "708-212-1412"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1611 W HARRISON ST",
"address_2": "SUITE 530",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606124861",
"telephone_number": "312-942-5332"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BACON",
"first_name": "MARY",
"middle_name": "J",
"name_prefix": "Ms.",
"credential": "M.A., CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-03",
"last_updated": "2015-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "146.001425",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.