Provider Demographics
NPI:1609385699
Name:DEMMA, ANTHONY JOSEPH (MHS CCC-SLP/L)
Entity Type:Individual
Prefix:MRS
First Name:ANTHONY
Middle Name:JOSEPH
Last Name:DEMMA
Suffix:
Gender:M
Credentials:MHS CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9800 S FRANCISCO AVE
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2624
Mailing Address - Country:US
Mailing Address - Phone:708-422-1021
Mailing Address - Fax:
Practice Address - Street 1:9800 S FRANCISCO AVE
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2624
Practice Address - Country:US
Practice Address - Phone:708-422-1021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-22
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146005765235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist