Doctor Name: | TRACI LYNN TAGUE |
NPI Number: | 1003147968 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA, CCC-SLP |
License Number: | 146.008233 |
Business Practice Address: | 4440 W 95th St Oak Lawn, IL - 604532600 |
Business Phone Number: | 7086841989 |
Business Fax Number: | |
Mailing Address: | 1218 W Wrightwood Ave, Unit G CHICAGO |
State: | IL |
Postal Code: | 606141224 |
Phone Number: | 2174176000 |
Fax Number: | |
NPI Enumeration Date: | 01/15/2010 |
NPI Last Update Date: | 01/15/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 146.008233 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |