Provider Demographics
NPI:1013972017
Name:REYES, TIMOTHY H (MS CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:H
Last Name:REYES
Suffix:
Gender:M
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:BENSENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60106-2033
Mailing Address - Country:US
Mailing Address - Phone:630-238-1995
Mailing Address - Fax:630-422-0262
Practice Address - Street 1:184 HENDERSON ST
Practice Address - Street 2:
Practice Address - City:BENSENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60106-2103
Practice Address - Country:US
Practice Address - Phone:630-238-1995
Practice Address - Fax:630-422-0262
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146005715235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist