Individual
MRS. DEBORAH PROVENZANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLPA
Contact information
Practice address
9736 S HAMILTON AVE, CHICAGO, IL 60643-1644
(773) 343-8484
(773) 305-0954
Mailing address
9736 S HAMILTON AVE, CHICAGO, IL 60643-1644
(773) 343-8484
(773) 305-0954
Taxonomy
Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01635583
BLUE CROSS BLUE SHIELD
IL
Enumeration date
03/21/2007
Last updated
07/08/2007
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