Provider Demographics
NPI:1043569106
Name:O'DONNELL, LAINIE JOY (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAINIE
Middle Name:JOY
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4646 N MARINE DR
Mailing Address - Street 2:OUTPATIENT PHYSICAL THERAPY DEPT. 1ST FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5759
Mailing Address - Country:US
Mailing Address - Phone:773-564-5425
Mailing Address - Fax:773-564-5689
Practice Address - Street 1:4646 N MARINE DR
Practice Address - Street 2:OUTPATIENT PHYSICAL THERAPY DEPT. 1ST FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5759
Practice Address - Country:US
Practice Address - Phone:773-564-5425
Practice Address - Fax:773-564-5689
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.009231235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist