Provider Demographics
NPI:1497797146
Name:DAILY, MARY SUE (MA,CCC-SP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:SUE
Last Name:DAILY
Suffix:
Gender:F
Credentials:MA,CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 MESA DR
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62629-9639
Mailing Address - Country:US
Mailing Address - Phone:217-483-7558
Mailing Address - Fax:
Practice Address - Street 1:915 MESA DR
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:IL
Practice Address - Zip Code:62629-9639
Practice Address - Country:US
Practice Address - Phone:217-483-7558
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
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