Provider Demographics
NPI:1194980185
Name:MUHAMMAD, SHIRLEY RENEE (SPL)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:RENEE
Last Name:MUHAMMAD
Suffix:
Gender:F
Credentials:SPL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 W 118TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-6028
Mailing Address - Country:US
Mailing Address - Phone:815-603-4823
Mailing Address - Fax:773-264-5424
Practice Address - Street 1:322 W 118TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-6028
Practice Address - Country:US
Practice Address - Phone:815-603-4823
Practice Address - Fax:773-264-5424
Is Sole Proprietor?:No
Enumeration Date:2008-07-19
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.003720235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist