Provider Demographics
NPI:1306901707
Name:BUCHANAN, CAROLYN JOAN (CCC SLP)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:JOAN
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 S SPRING AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2760
Mailing Address - Country:US
Mailing Address - Phone:708-482-2720
Mailing Address - Fax:
Practice Address - Street 1:1001 S SPRING AVE STE 200
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-2760
Practice Address - Country:US
Practice Address - Phone:708-482-2720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146007152235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist