Provider Demographics
NPI:1790087633
Name:LAVELLI, SHARON H (MS)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:H
Last Name:LAVELLI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:SHARI
Other - Middle Name:
Other - Last Name:SUMMERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:597 CROSSWIND LN
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60046-6747
Mailing Address - Country:US
Mailing Address - Phone:847-356-1646
Mailing Address - Fax:
Practice Address - Street 1:597 CROSSWIND LN
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:IL
Practice Address - Zip Code:60046-6747
Practice Address - Country:US
Practice Address - Phone:847-356-1646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-002203235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist