Provider Demographics
NPI:1891079844
Name:GATES, MAGGIE KATHLEEN (MA CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:KATHLEEN
Last Name:GATES
Suffix:
Gender:F
Credentials:MA CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1990 S KRISTINA LN
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-5622
Mailing Address - Country:US
Mailing Address - Phone:847-740-3495
Mailing Address - Fax:
Practice Address - Street 1:3516 WAUKEGAN RD
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-5732
Practice Address - Country:US
Practice Address - Phone:815-271-5249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.010796235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL146.010796OtherDEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION