Provider Demographics
NPI:1437441151
Name:GILL, COLLEEN S (MA, CCC-SLP/L)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:S
Last Name:GILL
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 1:7109 CARBUCK CT
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-7602
Mailing Address - Country:US
Mailing Address - Phone:630-470-3670
Mailing Address - Fax:
Practice Address - Street 1:58 STERLING CIR APT 205
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-2118
Practice Address - Country:US
Practice Address - Phone:630-470-3670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.010068235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist