Provider Demographics
NPI:1902174659
Name:EARL, ALICIA JONEKA (MAT, MS)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:JONEKA
Last Name:EARL
Suffix:
Gender:F
Credentials:MAT, MS
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:JONEKA
Other - Last Name:CURRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1122 N DEARBORN ST APT 15I
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-5069
Mailing Address - Country:US
Mailing Address - Phone:312-620-1460
Mailing Address - Fax:
Practice Address - Street 1:1122 N DEARBORN ST APT 15I
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-5069
Practice Address - Country:US
Practice Address - Phone:312-620-1460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP29490235Z00000X
TX116913235Z00000X
GASLP008849235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist