Provider Demographics
NPI:1649608548
Name:GARFINKEL, MARNI (MS)
Entity type:Individual
Prefix:
First Name:MARNI
Middle Name:
Last Name:GARFINKEL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W FULLERTON PKWY
Mailing Address - Street 2:UNIT 205E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2868
Mailing Address - Country:US
Mailing Address - Phone:847-302-1516
Mailing Address - Fax:
Practice Address - Street 1:1815 S WOLF RD
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:IL
Practice Address - Zip Code:60162-2110
Practice Address - Country:US
Practice Address - Phone:708-236-0979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-31
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242002708235Z00000X
IL146012137235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist