Provider Demographics
NPI:1427128305
Name:MCDERMOTT-WINTER, THERESE MARIE (MHS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:THERESE
Middle Name:MARIE
Last Name:MCDERMOTT-WINTER
Suffix:
Gender:F
Credentials:MHS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 W THOME AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-1820
Mailing Address - Country:US
Mailing Address - Phone:773-761-0016
Mailing Address - Fax:773-761-4213
Practice Address - Street 1:1416 W THOME AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-1820
Practice Address - Country:US
Practice Address - Phone:773-761-0016
Practice Address - Fax:773-754-8603
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-002647235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist