Provider Demographics
NPI:1326307299
Name:O'BRIEN, ELISE VALERIE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:VALERIE
Last Name:O'BRIEN
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 1:735 CHICAGO AVE
Mailing Address - Street 2:APT 232
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2373
Mailing Address - Country:US
Mailing Address - Phone:312-493-4716
Mailing Address - Fax:
Practice Address - Street 1:735 CHICAGO AVE
Practice Address - Street 2:APT 232
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-2373
Practice Address - Country:US
Practice Address - Phone:312-493-4716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146004935235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL146004935OtherSPEECH LANGUAGE PATHOLOGIST LICENSE