Provider Demographics
NPI:1508480963
Name:TEMENAK, MARK ANTHONY (MS, CCC-SLP B/L)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ANTHONY
Last Name:TEMENAK
Suffix:
Gender:M
Credentials:MS, CCC-SLP B/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3138 HILL LN
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2929
Mailing Address - Country:US
Mailing Address - Phone:630-923-4406
Mailing Address - Fax:
Practice Address - Street 1:3138 HILL LN
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2929
Practice Address - Country:US
Practice Address - Phone:630-923-4406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146014790235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist