Provider Demographics
NPI:1669971081
Name:CLISHAM, NORA J (MS, SLP-CCC)
Entity type:Individual
Prefix:MRS
First Name:NORA
Middle Name:J
Last Name:CLISHAM
Suffix:
Gender:F
Credentials:MS, SLP-CCC
Other - Prefix:MS
Other - First Name:NORA
Other - Middle Name:J
Other - Last Name:HEIDERSCHEIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6131 ALLEMONG DR
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-1061
Mailing Address - Country:US
Mailing Address - Phone:708-720-9435
Mailing Address - Fax:
Practice Address - Street 1:6131 ALLEMONG DR
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-1061
Practice Address - Country:US
Practice Address - Phone:708-720-9435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.013787235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist