Provider Demographics
NPI:1770742769
Name:RICAMATO, MICHELE DAWN (MACCC-SLP)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:DAWN
Last Name:RICAMATO
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3N243 VALEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-1310
Mailing Address - Country:US
Mailing Address - Phone:630-939-2570
Mailing Address - Fax:
Practice Address - Street 1:200 EASY ST STE H
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-2399
Practice Address - Country:US
Practice Address - Phone:630-939-2570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-005024235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist