Provider Demographics
NPI:1487867891
Name:SLOAN, IFY C (MS,SLP,CCC,L)
Entity Type:Individual
Prefix:MRS
First Name:IFY
Middle Name:C
Last Name:SLOAN
Suffix:
Gender:F
Credentials:MS,SLP,CCC,L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 N. TAYLOR AVE.
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302
Mailing Address - Country:US
Mailing Address - Phone:708-519-0786
Mailing Address - Fax:708-386-6727
Practice Address - Street 1:1104 N. TAYLOR AVE.
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302
Practice Address - Country:US
Practice Address - Phone:708-519-0786
Practice Address - Fax:708-386-6727
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146005777235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL506088870001Medicaid