Provider Demographics
NPI:1306575675
Name:DAVIS-BARNES, PHALON (MS, CFY-SLP)
Entity type:Individual
Prefix:
First Name:PHALON
Middle Name:
Last Name:DAVIS-BARNES
Suffix:
Gender:F
Credentials:MS, CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15510 CHAMPLAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-1350
Mailing Address - Country:US
Mailing Address - Phone:312-813-3024
Mailing Address - Fax:
Practice Address - Street 1:8001 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-5930
Practice Address - Country:US
Practice Address - Phone:773-436-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL000000000000Medicaid
000000000000000OtherPRIVATE