Provider Demographics
NPI:1083915672
Name:NINO, JOSI MARIE (SLP)
Entity Type:Individual
Prefix:
First Name:JOSI
Middle Name:MARIE
Last Name:NINO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5207 MAIN ST
Mailing Address - Street 2:STE 5
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-4652
Mailing Address - Country:US
Mailing Address - Phone:630-981-0032
Mailing Address - Fax:630-241-0884
Practice Address - Street 1:5207 MAIN ST
Practice Address - Street 2:STE 5
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-4652
Practice Address - Country:US
Practice Address - Phone:630-981-0032
Practice Address - Fax:630-241-0884
Is Sole Proprietor?:No
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146006939235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist