Provider Demographics
NPI:1083822332
Name:DAMMANN, MAUDE LOUISE (MT-BC, MATC)
Entity Type:Individual
Prefix:
First Name:MAUDE
Middle Name:LOUISE
Last Name:DAMMANN
Suffix:
Gender:F
Credentials:MT-BC, MATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 DODSON ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-1508
Mailing Address - Country:US
Mailing Address - Phone:630-301-2777
Mailing Address - Fax:
Practice Address - Street 1:421 DODSON ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-1508
Practice Address - Country:US
Practice Address - Phone:630-301-2777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILMD55090298P222Q00000X
IL04528225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Not Answered225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist