Provider Demographics
NPI:1912081324
Name:BRADY, ARNELL A (MA, CCC-SLP/L)
Entity type:Individual
Prefix:MR
First Name:ARNELL
Middle Name:A
Last Name:BRADY
Suffix:
Gender:M
Credentials:MA, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 E 53RD ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4500
Mailing Address - Country:US
Mailing Address - Phone:773-493-4000
Mailing Address - Fax:773-493-4003
Practice Address - Street 1:1424 E 53RD ST
Practice Address - Street 2:SUITE 307
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-4500
Practice Address - Country:US
Practice Address - Phone:773-493-4000
Practice Address - Fax:773-493-4003
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.003238235Z00000X
GASLP005099235Z00000X
ARSP#2227235Z00000X
CASP13298235Z00000X
IN22002765A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001671540OtherINSURANCE