Provider Demographics
NPI:1366676793
Name:BARNO, NICOLE R (MS, SLP-CCC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:R
Last Name:BARNO
Suffix:
Gender:F
Credentials:MS, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2042 W AUGUSTA BLVD
Mailing Address - Street 2:3F
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-4981
Mailing Address - Country:US
Mailing Address - Phone:773-931-8289
Mailing Address - Fax:
Practice Address - Street 1:2042 W AUGUSTA BLVD
Practice Address - Street 2:3F
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-4981
Practice Address - Country:US
Practice Address - Phone:773-931-8289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146010406235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist