Provider Demographics
NPI:1467579193
Name:BOLDMAN, RHEA FRIES (PHD)
Entity Type:Individual
Prefix:DR
First Name:RHEA
Middle Name:FRIES
Last Name:BOLDMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10737 S MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-1227
Mailing Address - Country:US
Mailing Address - Phone:773-680-3084
Mailing Address - Fax:773-779-1641
Practice Address - Street 1:10737 S MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-1227
Practice Address - Country:US
Practice Address - Phone:773-680-3084
Practice Address - Fax:773-779-1641
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist