Provider Demographics
NPI:1538553425
Name:CALVADORES, MARY GRACE (MS,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MARY GRACE
Middle Name:
Last Name:CALVADORES
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:MISS
Other - First Name:MARY GRACE
Other - Middle Name:
Other - Last Name:MARAVILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:5321 N LINCOLN AVE
Mailing Address - Street 2:4B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3988
Mailing Address - Country:US
Mailing Address - Phone:773-230-7910
Mailing Address - Fax:
Practice Address - Street 1:5321 N LINCOLN AVE
Practice Address - Street 2:4B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3988
Practice Address - Country:US
Practice Address - Phone:773-230-7910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146011894235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist