Provider Demographics
NPI:1669032835
Name:MCCUTCHEON-NUNN, ANNA ELIZABETH (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:ELIZABETH
Last Name:MCCUTCHEON-NUNN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:ELIZABETH
Other - Last Name:HALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:NSPT
Mailing Address - Street 2:707 LAKE COOK ROAD SUITE 312
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015
Mailing Address - Country:US
Mailing Address - Phone:757-455-5000
Mailing Address - Fax:757-319-4142
Practice Address - Street 1:NORTH SHORE PEDIATRIC THERAPY- DEERFIELD
Practice Address - Street 2:707 LAKE COOK ROAD SUITE 312
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015
Practice Address - Country:US
Practice Address - Phone:877-985-3601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204000259235Z00000X
VA2202009575235Z00000X
IL146015747235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist