Provider Demographics
NPI:1124804075
Name:SCANLON, SOPHIE (CF-SLP)
Entity type:Individual
Prefix:
First Name:SOPHIE
Middle Name:
Last Name:SCANLON
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 1:5350 ARCADIA ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1531
Mailing Address - Country:US
Mailing Address - Phone:224-456-4707
Mailing Address - Fax:
Practice Address - Street 1:8701 MENARD AVE
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-3052
Practice Address - Country:US
Practice Address - Phone:847-965-9040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242007420235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist