Provider Demographics
NPI:1437725447
Name:MACDONALD, ERIN MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:MARIE
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18160 W GAGES LAKE RD
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-1819
Mailing Address - Country:US
Mailing Address - Phone:854-548-8470
Mailing Address - Fax:
Practice Address - Street 1:18160 W GAGES LAKE RD
Practice Address - Street 2:
Practice Address - City:GAGES LAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-1819
Practice Address - Country:US
Practice Address - Phone:847-548-8470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
IL146014910235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist