Provider Demographics
NPI:1285666990
Name:ROMAN, JUDITH O (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:O
Last Name:ROMAN
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 1:517 WARREN RD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-4676
Mailing Address - Country:US
Mailing Address - Phone:847-832-1102
Mailing Address - Fax:
Practice Address - Street 1:517 WARREN RD
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-4676
Practice Address - Country:US
Practice Address - Phone:847-832-1102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist