Doctor Name: | DEIDRA DAWN PARKS |
NPI Number: | 1508012352 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S. CCC/SLP |
License Number: | 146.005992 |
Business Practice Address: | 16721 E Kendall Rd Mount Vernon, IL - 628642077 |
Business Phone Number: | 6182142883 |
Business Fax Number: | |
Mailing Address: | 16721 E Kendall Rd, MOUNT VERNON |
State: | IL |
Postal Code: | 628642077 |
Phone Number: | 6182142883 |
Fax Number: | |
NPI Enumeration Date: | 08/12/2008 |
NPI Last Update Date: | 08/12/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 146.005992 |
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 |