Mikayla Clark
Individual provider Active NPI Speech-Language Pathologist · Countryside, IL
NPI 1497587455 · NPPES record last updated Aug 19, 2024
Key facts
- NPI
- 1497587455
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- Practice address
- 9649 W 55TH St
Countryside, IL 60525-3699 - Phone
- (708) 352-3580
- Fax
- (708) 352-2715
- NPI assigned
- Aug 19, 2024
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | Yes |
Addresses
Primary practice location
9649 W 55TH St
Countryside, IL 60525-3699
Mailing address
9649 W 55TH St
Countryside, IL 60525-3699
Phone (708) 352-3580
Other providers in Countryside, IL
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- Eileen Diane Caadan Chavez
- Marquez Chew
- Seema Choudhury
- Natalie Grace Cochran
- Cornerstone Caregiving East LLC
- Eduardo Cortez
- Countryside Dental Group, PC
- Countryside Medical SC
All providers in Countryside, IL · Speech-Language Pathologist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 19, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.