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Individual

MISS EMILY R GOMEZTAGLE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MS-SLP-CCC

Contact information

Practice address
5130 W JACKSON BLVD, CHICAGO, IL 60644-4332
(219) 308-9477
Mailing address
2348 N LISTER AVE, 207, CHICAGO, IL 60614-2994
(219) 308-9477

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146011739
IL
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
05/22/2012
Last updated
03/07/2014
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