Provider Demographics
NPI:1306904263
Name:OHARA SHELTON, AMANDA SUE (SLP)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:SUE
Last Name:OHARA SHELTON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:SUE
Other - Last Name:OHARA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLP
Mailing Address - Street 1:711 W GORDON TER
Mailing Address - Street 2:#313
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613
Mailing Address - Country:US
Mailing Address - Phone:773-339-2117
Mailing Address - Fax:847-674-4042
Practice Address - Street 1:8833 GROSS POINT RD
Practice Address - Street 2:SUITE 308
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1859
Practice Address - Country:US
Practice Address - Phone:847-674-2630
Practice Address - Fax:847-974-4042
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist