Provider Demographics
NPI:1437333739
Name:PERRY, DANA A (MA, CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:A
Last Name:PERRY
Suffix:
Gender:F
Credentials:MA, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5203 S INGLESIDE AVE
Mailing Address - Street 2:UNIT 3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4307
Mailing Address - Country:US
Mailing Address - Phone:773-402-9062
Mailing Address - Fax:
Practice Address - Street 1:5203 S INGLESIDE AVE
Practice Address - Street 2:UNIT 3
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-4307
Practice Address - Country:US
Practice Address - Phone:773-402-9062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16525235Z00000X
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist