Provider Demographics
NPI:1891304861
Name:DIAMOND, ELAINE (MS SLP-CF)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:MS SLP-CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 N SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-2081
Mailing Address - Country:US
Mailing Address - Phone:224-303-1029
Mailing Address - Fax:
Practice Address - Street 1:601 BLANCHARD RD
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60087-3146
Practice Address - Country:US
Practice Address - Phone:224-303-1570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.006019235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist