Provider Demographics
NPI:1811163819
Name:BASU, GAURI S (MS, CCC-SLP/L)
Entity type:Individual
Prefix:MS
First Name:GAURI
Middle Name:S
Last Name:BASU
Suffix:
Gender:F
Credentials:MS, CCC-SLP/L
Other - Prefix:
Other - First Name:GAURI
Other - Middle Name:S
Other - Last Name:TAMBAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP/L
Mailing Address - Street 1:719 WOODEWIND DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-4046
Mailing Address - Country:US
Mailing Address - Phone:630-548-3115
Mailing Address - Fax:
Practice Address - Street 1:1936 BROOKDALE RD
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-2015
Practice Address - Country:US
Practice Address - Phone:630-548-4604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146006642235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL146006642OtherILLINOIS LICENSE NUMBER