Provider Demographics
NPI:1003188863
Name:D'AQUILA, GENEVIEVE MARIE
Entity Type:Individual
Prefix:MRS
First Name:GENEVIEVE
Middle Name:MARIE
Last Name:D'AQUILA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 W WASHINGTON BLVD
Mailing Address - Street 2:NO. 712
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2204
Mailing Address - Country:US
Mailing Address - Phone:312-421-1654
Mailing Address - Fax:
Practice Address - Street 1:1366 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2129
Practice Address - Country:US
Practice Address - Phone:772-248-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146009555235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist