Provider Demographics
NPI:1558566729
Name:XIQUES, CAROL ANN (DT)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANN
Last Name:XIQUES
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1834 W BIRCHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-1515
Mailing Address - Country:US
Mailing Address - Phone:773-338-6281
Mailing Address - Fax:
Practice Address - Street 1:1834 W BIRCHWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-1515
Practice Address - Country:US
Practice Address - Phone:773-338-6281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist