Provider Demographics
NPI:1386968519
Name:KING, EBONI D (SLP)
Entity type:Individual
Prefix:MS
First Name:EBONI
Middle Name:D
Last Name:KING
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8639 S WINCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60620-6012
Mailing Address - Country:US
Mailing Address - Phone:773-771-4110
Mailing Address - Fax:773-233-2730
Practice Address - Street 1:8639 S. WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-6012
Practice Address - Country:US
Practice Address - Phone:773-771-4110
Practice Address - Fax:773-233-2730
Is Sole Proprietor?:No
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242001235235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist