Provider Demographics
NPI:1144786724
Name:NELSON, SHEILA ODONNELL (SLP)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:ODONNELL
Last Name:NELSON
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 1:614 E PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-2618
Mailing Address - Country:US
Mailing Address - Phone:847-791-1058
Mailing Address - Fax:
Practice Address - Street 1:1820 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-6052
Practice Address - Country:US
Practice Address - Phone:847-400-8738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146002723235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist