Active NPI
Collen Gavin
- Speech-Language Pathologist
- Orland Park, IL
National Provider Identifier
1508364324
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 146004236
- Practice address
- 14855 West Ave
Orland Park, IL 60462-3144 - Phone
- (708) 364-4252
- NPI assigned
- Jan 26, 2018
- 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 | 146004236 | IL | Primary |
Addresses
Primary practice location
14855 West Ave
Orland Park, IL 60462-3144
Mailing address
15007 Hale Dr
Orland Park, IL 60462-3129
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 146004236 | IL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1516924800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1583366400000",
"number": "1508364324",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15007 HALE DR",
"city": "ORLAND PARK",
"state": "IL",
"postal_code": "604623129"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14855 WEST AVE",
"city": "ORLAND PARK",
"state": "IL",
"postal_code": "604623144",
"telephone_number": "708-364-4252"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAVIN",
"first_name": "COLLEN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-01-26",
"last_updated": "2020-03-05",
"certification_date": "2020-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "146004236",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orland Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.