Provider Demographics
NPI:1457044034
Name:ILACQUA, CHLOE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:CHLOE
Middle Name:
Last Name:ILACQUA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11982 BRANDYWINE DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-9087
Mailing Address - Country:US
Mailing Address - Phone:248-330-9640
Mailing Address - Fax:
Practice Address - Street 1:1101 S RAISINVILLE RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-9047
Practice Address - Country:US
Practice Address - Phone:734-242-5799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist