Provider Demographics
NPI:1316079858
Name:CARLMARK, NANETTE JOANN (MA CCC SLP)
Entity type:Individual
Prefix:
First Name:NANETTE
Middle Name:JOANN
Last Name:CARLMARK
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:NANETTE
Other - Middle Name:JOANN
Other - Last Name:DAHLKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA CCC SLP
Mailing Address - Street 1:704 S DYMOND RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3028
Mailing Address - Country:US
Mailing Address - Phone:847-571-5044
Mailing Address - Fax:847-549-1347
Practice Address - Street 1:704 S DYMOND RD
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3028
Practice Address - Country:US
Practice Address - Phone:847-571-5044
Practice Address - Fax:847-549-1347
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
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