Provider Demographics
NPI:1619482270
Name:MURPHY, THERESA (SPEECH-LANGUAGE PATH)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:MURPHY
Suffix:
Gender:F
Credentials:SPEECH-LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 CONCORD PL
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-5124
Mailing Address - Country:US
Mailing Address - Phone:630-484-4106
Mailing Address - Fax:
Practice Address - Street 1:1019 CONCORD PL
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561-5124
Practice Address - Country:US
Practice Address - Phone:630-484-4106
Practice Address - Fax:331-481-4015
Is Sole Proprietor?:No
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL658194235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist