Provider Demographics
NPI:1366682460
Name:SANTIAGO, EVIS M (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:EVIS
Middle Name:M
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4426 N KEELER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-4223
Mailing Address - Country:US
Mailing Address - Phone:773-719-0890
Mailing Address - Fax:773-427-0941
Practice Address - Street 1:4426 N KEELER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-4223
Practice Address - Country:US
Practice Address - Phone:773-719-0890
Practice Address - Fax:773-427-0941
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.008003235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist