Mary T Lake, SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Practice address

15700 Terrace Dr # P102
Oak Forest, IL 60452-2959

Phone

(708) 717-4924

Fax

(815) 464-8431

NPI assigned

May 11, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1821203100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15700 TERRACE DR # P102",
            "city": "OAK FOREST",
            "state": "IL",
            "postal_code": "604522959",
            "telephone_number": "708-717-4924",
            "fax_number": "815-464-8431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15700 TERRACE DR # P102",
            "city": "OAK FOREST",
            "state": "IL",
            "postal_code": "604522959",
            "telephone_number": "708-717-4924",
            "fax_number": "815-464-8431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKE",
        "first_name": "MARY",
        "middle_name": "T",
        "credential": "SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Admasu Kumssa, MD
• Daniel Kunz, ATC
• Kristen Kwasny
• Amanda Kaitlyn Labash, LCSW
• Zaia Ishaq Lachin, MD
• Barbara Lynn Lange, DPM
• Harrison Leibow
• Mary Rene Leonhardt
• Philip James Levoy, D.D.S.
• Kristen E Licata, M.S., CCC-SLP/L

• Speech-Language Pathologist in Oak Forest, IL
• Providers in Oak Forest, IL by specialty
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.