MRS. DEBORAH PROVENZANO (NPI# 1164548376) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164548376 |
| Entity Type | Individual |
| Full Name | MRS. DEBORAH PROVENZANO |
| Credential | SLPA |
| Practice Address |
9736 S Hamilton Ave Chicago IL 60643-1644 |
| Practice Telephone | 7733438484 |
| Practice Fax Number | 7733050954 |
| Mailing Telephone | 7733438484 |
| Mailing Fax Number | 7733050954 |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2355S0801X |
Specialist/Technologist Specialization: Speech-Language Assistant |
IL | Speech, Language and Hearing Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BLUE CROSS BLUE SHIELD | 01635583 | 01 |
| Street Address |
9736 S HAMILTON AVE |
| City | CHICAGO |
| State | IL |
| Zip Code | 60643-1644 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174632186 | Square One Kids, LLC | Speech-Language Pathologist | 9736 S Hamilton Ave, Chicago, IL 60643-1644 | 2006-08-30 |
| 1821117573 | Susan Marie Connor | Specialist | 9736 S Hamilton Ave, Chicago, IL 60643-1644 | 2007-03-27 |
| 1386753226 | Diane Vasilevich | Speech-Language Pathologist | 9736 S Hamilton Ave, Chicago, IL 60643-1644 | 2006-08-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154941698 | Breann Hampton | Behavior Technician | 1214 W 115th St, Chicago, IL 60643 | 2020-04-24 |
| 1366075566 | Sanctuary Counseling, LLC | Home Health | 12247 S Racine Ave, Calumet Park, IL 60643 | 2020-02-16 |
| 1467082883 | Juliana Frances Cunningham | Developmental Therapist | 10037 S Bell, Chicago, IL 60643 | 2020-01-24 |
| 1013578624 | Sct Counseling | Counselor | 11948 S Western Ave, Chicago, IL 60643 | 2019-06-25 |
| 1073087474 | For Eyes Optical Company of Pa | Optometrist | 9900 S Ridgleland Ave, Chicago Ridge, IL 60643 | 2019-01-18 |
| 1073096426 | Derek Peake | Physical Therapist | 9465 S. Western Road, Chicago, IL 60643 | 2018-09-12 |
| 1508356072 | Halo Medical Professionals Sc. | Chiropractor | 10650 S Western Ave, Chicago, IL 60643 | 2018-05-10 |
| 1811405699 | Kara Eileen Noland | Developmental Therapist | 9327 S Hamilton Ave, Chicago, IL 60643 | 2018-01-16 |
| 1588173546 | Kiah Nicole Bouie | Behavioral Analyst | 1461 W 113th Pl, Chicago, IL 60643 | 2017-09-21 |
| 1174042766 | Travis Wade Robertson | Physical Therapist | 10909-11 S Western Ave, Beverly, IL 60643 | 2017-09-14 |
| Find all providers in zip 60643 | ||||
| Taxonomy Code | 2355S0801X |
| Grouping | Speech, Language and Hearing Service Providers |
| Classification | Specialist/Technologist |
| Specialization | Speech-Language Assistant |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427666825 | Claudia Diane Sudduth | Specialist/Technologist | 2047 E 75th St Apt 2b, Chicago, IL 60649-3637 | 2020-07-21 |
| 1396381067 | Casey Malman | Specialist/Technologist | 901 W Madison St Unit 701, Chicago, IL 60607-3372 | 2019-11-18 |
| 1992282669 | Molly M Binder | Specialist/Technologist | 2889 N Milwaukee Ave Apt 2r, Chicago, IL 60618-7422 | 2018-07-25 |
| 1649765702 | Isabel Hernandez | Specialist/Technologist | 1314 N Rockwell St Apt 3, Chicago, IL 60622-1236 | 2018-06-29 |
| 1922550276 | Gail Louise Akins | Specialist/Technologist | 3734 W 82nd St, Chicago, IL 60652-2434 | 2016-11-02 |
| 1073968012 | Agnieszka Dominika Lenart | Specialist/Technologist | 7170 W Grand Ave, Apt 4e, Chicago, IL 60707-2862 | 2016-04-27 |
| 1477929487 | Adrienne Cherry | Specialist/Technologist | 1529 E 86th St, Chicago, IL 60619-6518 | 2015-08-12 |
| 1376941161 | Corey Michelle Friedli | Specialist/Technologist | 3136 S Prairie Ave Apt 2, Chicago, IL 60616-3904 | 2014-12-11 |
| 1508275769 | Laura Pritchard | Specialist/Technologist | 1010 N Hooker Street, Suite 301, Chicago, IL 60642-4633 | 2014-08-12 |
| 1851714406 | Tasha Hammond | Specialist/Technologist | 1837 E 84th St, Apt #3, Chicago, IL 60617-2200 | 2014-01-31 |
| Find all providers in CHICAGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.