Provider Demographics
NPI:1477882751
Name:HENEGHAN, TRICIA (AUD)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:HENEGHAN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 TOWER DR
Mailing Address - Street 2:STE D8
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-7803
Mailing Address - Country:US
Mailing Address - Phone:312-263-7171
Mailing Address - Fax:312-263-5438
Practice Address - Street 1:806 CENTRAL AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-5613
Practice Address - Country:US
Practice Address - Phone:847-433-7617
Practice Address - Fax:847-681-7000
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-15
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147000742231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147000742OtherDEPARTMENT OF FINANCIAL & PROFESSIONAL REGULATION