Provider Demographics
NPI:1538400494
Name:CRISSIE, DENA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:DENA
Middle Name:
Last Name:CRISSIE
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 1:578 CHESTERFIELD LN
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-6525
Mailing Address - Country:US
Mailing Address - Phone:847-540-7637
Mailing Address - Fax:
Practice Address - Street 1:578 CHESTERFIELD LN
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-6525
Practice Address - Country:US
Practice Address - Phone:847-540-7637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.10467235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist