Provider Demographics
NPI:1285807388
Name:CLIFFORD, THERESA ELIZABETH (MACCC-SLP)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:ELIZABETH
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3708 LAWRENCE DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-4172
Mailing Address - Country:US
Mailing Address - Phone:630-631-3094
Mailing Address - Fax:630-904-9212
Practice Address - Street 1:3708 LAWRENCE DR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-4172
Practice Address - Country:US
Practice Address - Phone:630-631-3094
Practice Address - Fax:630-904-9212
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist