Provider Demographics
NPI:1821123886
Name:SLONIM, ELLISA (MA CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ELLISA
Middle Name:
Last Name:SLONIM
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5116 BIRCHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-3350
Mailing Address - Country:US
Mailing Address - Phone:847-677-7730
Mailing Address - Fax:
Practice Address - Street 1:520 N MARSHFIELD AVE
Practice Address - Street 2:ESPERANZA EARLY INTERVENTION PROGRAM
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-6731
Practice Address - Country:US
Practice Address - Phone:312-432-3944
Practice Address - Fax:312-432-1278
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist