Provider Demographics
NPI:1689797599
Name:DONNELLY, EILEEN CATHERINE (MS)
Entity Type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:CATHERINE
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 W 101ST ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-1044
Mailing Address - Country:US
Mailing Address - Phone:708-668-3301
Mailing Address - Fax:
Practice Address - Street 1:2620 W 101ST ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-1044
Practice Address - Country:US
Practice Address - Phone:708-668-3301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist