Provider Demographics
NPI:1467658583
Name:MADDEN DAMM, MARY BETH (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARY BETH
Middle Name:
Last Name:MADDEN DAMM
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:MADDEN DAMM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6300 BARBARA AVE
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-2957
Mailing Address - Country:US
Mailing Address - Phone:708-429-3894
Mailing Address - Fax:708-429-3894
Practice Address - Street 1:6300 BARBARA AVE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-2957
Practice Address - Country:US
Practice Address - Phone:708-429-3894
Practice Address - Fax:708-429-3894
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
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