Provider Demographics
NPI:1760906028
Name:POTEMPA (MASO), MONICA
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:POTEMPA (MASO)
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:MASO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7132 W LEE ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-2222
Mailing Address - Country:US
Mailing Address - Phone:847-965-3038
Mailing Address - Fax:
Practice Address - Street 1:7132 W LEE ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-2222
Practice Address - Country:US
Practice Address - Phone:847-965-3038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-28
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146003870235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist