Provider Demographics
NPI:1689865693
Name:MAUREEN T. GRADY, SPEECH LANGUAGE PATHOLOGIST, LLC
Entity Type:Organization
Organization Name:MAUREEN T. GRADY, SPEECH LANGUAGE PATHOLOGIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:GRADY
Authorized Official - Last Name:COONEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:773-841-8180
Mailing Address - Street 1:10553 S OAKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-2525
Mailing Address - Country:US
Mailing Address - Phone:773-841-8180
Mailing Address - Fax:
Practice Address - Street 1:10553 S OAKLEY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-2525
Practice Address - Country:US
Practice Address - Phone:773-841-8180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2016-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.008643261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech