Provider Demographics
NPI:1386724060
Name:BRAVERMAN, DEVIDA MICHELLE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:DEVIDA
Middle Name:MICHELLE
Last Name:BRAVERMAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 SAUGATUCK TRL
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-3243
Mailing Address - Country:US
Mailing Address - Phone:847-362-2971
Mailing Address - Fax:
Practice Address - Street 1:1860 W WINCHESTER RD
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5351
Practice Address - Country:US
Practice Address - Phone:847-573-9486
Practice Address - Fax:847-549-6139
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.000748235Z00000X
IL146-000748235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist