Provider Demographics
NPI:1689879819
Name:WADDICK, MANDY (MS CCC SLP)
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:WADDICK
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:
Other - Last Name:WADDICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLP-CCC/L
Mailing Address - Street 1:10611 S HAMLIN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-3810
Mailing Address - Country:US
Mailing Address - Phone:773-640-4240
Mailing Address - Fax:
Practice Address - Street 1:10611 S HAMLIN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-3810
Practice Address - Country:US
Practice Address - Phone:773-640-4240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-007740235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist