Provider Demographics
NPI:1073177044
Name:MCQUAID, MAUREEN E (MS)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:E
Last Name:MCQUAID
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:MAUREEN
Other - Middle Name:
Other - Last Name:NELLIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9825 S CENTRAL PARK AVE
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-3006
Mailing Address - Country:US
Mailing Address - Phone:708-822-2659
Mailing Address - Fax:
Practice Address - Street 1:7600 MASON AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-1200
Practice Address - Country:US
Practice Address - Phone:708-496-3330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14150586Medicaid
IL14150586OtherAMERICAN SPEECH AND HEARING ASSOCIATION