Provider Demographics
NPI:1295393262
Name:HARRIGAN, ELISE MARIE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:MARIE
Last Name:HARRIGAN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5242 W 107TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-6302
Mailing Address - Country:US
Mailing Address - Phone:708-712-9601
Mailing Address - Fax:
Practice Address - Street 1:11053 S MILLARD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-3327
Practice Address - Country:US
Practice Address - Phone:773-253-9856
Practice Address - Fax:773-253-9876
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14258909235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty