Provider Demographics
NPI:1063683894
Name:DOMINGO, JANE ELLEN HARRIS (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:ELLEN HARRIS
Last Name:DOMINGO
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Gender:F
Credentials:MS, CCC-SLP
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Mailing Address - Street 1:1401 S CALIFORNIA AVE
Mailing Address - Street 2:SCHWAB REHABILITATION HOSPITAL
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-1858
Mailing Address - Country:US
Mailing Address - Phone:773-522-6511
Mailing Address - Fax:773-522-5840
Practice Address - Street 1:5333 N SHERIDAN RD
Practice Address - Street 2:GENESIS REHABILITATION
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-7371
Practice Address - Country:US
Practice Address - Phone:773-271-5189
Practice Address - Fax:773-271-5109
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2012-08-06
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Provider Licenses
StateLicense IDTaxonomies
IL146006946235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist