Individual
MS. JEANNE MIMI GOURGUECHON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DTH
Contact information
Practice address
2042 W MORSE AVE, CHICAGO, IL 60645-4955
(773) 495-6627
(773) 274-4276
Mailing address
2042 W MORSE AVE, CHICAGO, IL 60645-4955
(773) 495-6627
(773) 274-4276
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
JG39350902P
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
JG39350902P
EARLY INTERVENTION
IL
Enumeration date
03/04/2007
Last updated
07/08/2007
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