Provider Demographics
NPI:1740474923
Name:NEARY, MICHAEL JOHN JR (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOHN
Last Name:NEARY
Suffix:JR
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 1:1301 W MADISON ST
Mailing Address - Street 2:#512
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-1936
Mailing Address - Country:US
Mailing Address - Phone:312-850-3128
Mailing Address - Fax:
Practice Address - Street 1:1301 W MADISON ST
Practice Address - Street 2:#512
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-1936
Practice Address - Country:US
Practice Address - Phone:312-850-3128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist