Provider Demographics
NPI:1285978361
Name:ENGLEHART, MARY THERESE (MS CCC/SLP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:THERESE
Last Name:ENGLEHART
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12840 S SYCAMORE LN
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1939
Mailing Address - Country:US
Mailing Address - Phone:708-448-8048
Mailing Address - Fax:
Practice Address - Street 1:12840 S SYCAMORE LN
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1939
Practice Address - Country:US
Practice Address - Phone:708-448-8048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.004452235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist