Provider Demographics
NPI:1912482415
Name:CHAN, ELEANORE SHARON (CF-SLP)
Entity Type:Individual
Prefix:
First Name:ELEANORE
Middle Name:SHARON
Last Name:CHAN
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 W SPRINGFIELD AVE APT T4
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-2858
Mailing Address - Country:US
Mailing Address - Phone:312-451-1456
Mailing Address - Fax:
Practice Address - Street 1:136 S DIPPER LN
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62522-1841
Practice Address - Country:US
Practice Address - Phone:217-428-7767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.005156235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist