Provider Demographics
NPI:1760611669
Name:MARRERO, MAGALY E (MS)
Entity Type:Individual
Prefix:MS
First Name:MAGALY
Middle Name:E
Last Name:MARRERO
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 1:833 W BUENA AVE
Mailing Address - Street 2:APT 2009
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-6600
Mailing Address - Country:US
Mailing Address - Phone:773-244-9838
Mailing Address - Fax:
Practice Address - Street 1:348 55TH ST
Practice Address - Street 2:
Practice Address - City:CLARENDON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60514-3015
Practice Address - Country:US
Practice Address - Phone:787-362-8887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.009175235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist