Provider Demographics
NPI:1720215833
Name:O'BRIEN, EMILY JAN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JAN
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1542 N BOSWORTH AVE
Mailing Address - Street 2:UNIT 3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-2350
Mailing Address - Country:US
Mailing Address - Phone:312-550-0576
Mailing Address - Fax:773-697-7738
Practice Address - Street 1:1542 N BOSWORTH AVE
Practice Address - Street 2:UNIT 3
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-2350
Practice Address - Country:US
Practice Address - Phone:312-550-0576
Practice Address - Fax:773-697-7738
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.009813235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist