Provider Demographics
NPI:1144843186
Name:DRAPER, MARGO ELLEN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARGO
Middle Name:ELLEN
Last Name:DRAPER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19520 BLYTH WAY
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-7977
Mailing Address - Country:US
Mailing Address - Phone:708-475-5553
Mailing Address - Fax:
Practice Address - Street 1:19520 BLYTH WAY
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-7977
Practice Address - Country:US
Practice Address - Phone:708-475-5553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.015308235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist