Provider Demographics
NPI:1366547911
Name:BYRD, GRETCHEN M (MS, CCC-SLP/L)
Entity type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:M
Last Name:BYRD
Suffix:
Gender:F
Credentials:MS, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 E. SCHOOLHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560
Mailing Address - Country:US
Mailing Address - Phone:630-553-6888
Mailing Address - Fax:630-553-3737
Practice Address - Street 1:29D STONEHILL
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543
Practice Address - Country:US
Practice Address - Phone:630-554-6156
Practice Address - Fax:630-554-6378
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146008664235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist