Provider Demographics
NPI:1629337597
Name:ATCHLEY, JOHN EDGAR (MA, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:EDGAR
Last Name:ATCHLEY
Suffix:
Gender:M
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 N. MICHIGAN AVENUE
Mailing Address - Street 2:SUITE 3100
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-1803
Mailing Address - Country:US
Mailing Address - Phone:877-800-9480
Mailing Address - Fax:
Practice Address - Street 1:875 N. MICHIGAN AVENUE
Practice Address - Street 2:SUITE 3100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-1803
Practice Address - Country:US
Practice Address - Phone:877-800-9480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-006180235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist