Provider Demographics
NPI:1033126404
Name:MASSA, GEORGIANN K (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:GEORGIANN
Middle Name:K
Last Name:MASSA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 S SUNNYSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-3727
Mailing Address - Country:US
Mailing Address - Phone:630-833-8614
Mailing Address - Fax:630-833-8650
Practice Address - Street 1:410 S SUNNYSIDE AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-3727
Practice Address - Country:US
Practice Address - Phone:630-833-8614
Practice Address - Fax:630-833-8650
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist