Provider Demographics
NPI:1083359764
Name:O'MALLEY, ROSEANNE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ROSEANNE
Middle Name:
Last Name:O'MALLEY
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 1:5201 S MOODY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-1434
Mailing Address - Country:US
Mailing Address - Phone:815-600-4249
Mailing Address - Fax:
Practice Address - Street 1:6700 S KEATING AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-5660
Practice Address - Country:US
Practice Address - Phone:773-800-2201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146009335235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist