Provider Demographics
NPI:1285147629
Name:REID, MARYLEE (MA, CCC-SLP, CBIS)
Entity type:Individual
Prefix:
First Name:MARYLEE
Middle Name:
Last Name:REID
Suffix:
Gender:F
Credentials:MA, CCC-SLP, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8301 DAVID DR APT G
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-4418
Mailing Address - Country:US
Mailing Address - Phone:630-550-8645
Mailing Address - Fax:
Practice Address - Street 1:1390 S CRESCENT ST
Practice Address - Street 2:
Practice Address - City:GILMAN
Practice Address - State:IL
Practice Address - Zip Code:60938-6129
Practice Address - Country:US
Practice Address - Phone:815265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP25743235Z00000X
IL146.003461235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty