Provider Demographics
NPI:1154569416
Name:HAGUE, AMY TIMMONS (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:TIMMONS
Last Name:HAGUE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1661
Mailing Address - Country:US
Mailing Address - Phone:847-728-0580
Mailing Address - Fax:
Practice Address - Street 1:2530 CRAWFORD AVE STE 301
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4972
Practice Address - Country:US
Practice Address - Phone:312-550-5336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-25
Last Update Date:2022-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146004390235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist