Basic Information
| Provider Information | |||||||||
| NPI: | 1770009938 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COREN | ||||||||
| FirstName: | SHELBY | ||||||||
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| Credential: | M.S., CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1217 CAVELL AVE | ||||||||
| Address2: | |||||||||
| City: | HIGHLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600352913 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 310 N LOOMIS ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606071147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3122438487 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2017 | ||||||||
| LastUpdateDate: | 07/08/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 242.004430 | IL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.