Provider Demographics
NPI:1649769902
Name:FORDE, NANCY (MHS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:FORDE
Suffix:
Gender:F
Credentials:MHS, CCC-SLP
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:MULKERRINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHS, CCC-SLP
Mailing Address - Street 1:5638 N ASHLAND AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-4114
Mailing Address - Country:US
Mailing Address - Phone:773-850-7857
Mailing Address - Fax:
Practice Address - Street 1:4637 N ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-4630
Practice Address - Country:US
Practice Address - Phone:312-208-8266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146013056235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist