Provider Demographics
NPI:1457532160
Name:VEALE, TINA KATHALEEN (PHD, CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:KATHALEEN
Last Name:VEALE
Suffix:
Gender:F
Credentials:PHD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 GREENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-6235
Mailing Address - Country:US
Mailing Address - Phone:217-218-6683
Mailing Address - Fax:
Practice Address - Street 1:3450 LACEY ROAD
Practice Address - Street 2:MIDWESTERN UNIVERSITY MULTISPECIALTY CLINIC
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515
Practice Address - Country:US
Practice Address - Phone:630-743-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-21
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.006625235Z00000X
OHSP-2536235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
00166876OtherASHA CCC
OHSP-2536OtherOHIO LICENSE--SLP
IL146.006625OtherILLINOIS LICENSE--SLP
OHSP-2536OtherOHIO LICENSE--SLP