Provider Demographics
NPI:1588673388
Name:WHITESELL, EMILIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:EMILIE
Middle Name:
Last Name:WHITESELL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3526 N BOSWORTH AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-1364
Mailing Address - Country:US
Mailing Address - Phone:773-662-6681
Mailing Address - Fax:773-304-2765
Practice Address - Street 1:3526 N BOSWORTH AVE APT 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-1364
Practice Address - Country:US
Practice Address - Phone:773-662-6681
Practice Address - Fax:773-304-2765
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146008169235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist