Provider Demographics
NPI:1235484064
Name:GAINES, SHAWANDA (MS, CCC-SLP/L)
Entity Type:Individual
Prefix:MRS
First Name:SHAWANDA
Middle Name:
Last Name:GAINES
Suffix:
Gender:F
Credentials:MS, CCC-SLP/L
Other - Prefix:MRS
Other - First Name:SHAWANDA
Other - Middle Name:GAINES
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:42 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-4309
Mailing Address - Country:US
Mailing Address - Phone:773-553-1000
Mailing Address - Fax:
Practice Address - Street 1:8052 S. GREEN STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-2545
Practice Address - Country:US
Practice Address - Phone:708-507-5511
Practice Address - Fax:708-757-7145
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL12085491235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist