Provider Demographics
NPI:1851502439
Name:IZAGUIRRE, DOREEN KELLY (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DOREEN
Middle Name:KELLY
Last Name:IZAGUIRRE
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 1:3134 N CLIFTON AVE
Mailing Address - Street 2:UNIT 2 WEST
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3335
Mailing Address - Country:US
Mailing Address - Phone:773-665-2791
Mailing Address - Fax:
Practice Address - Street 1:3134 N CLIFTON AVE
Practice Address - Street 2:UNIT 2 WEST
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3335
Practice Address - Country:US
Practice Address - Phone:773-665-2791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
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