Provider Demographics
NPI:1083501589
Name:IRVINE, NANCY CATHERINE
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:CATHERINE
Last Name:IRVINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 S EAST AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-2103
Mailing Address - Country:US
Mailing Address - Phone:708-724-3975
Mailing Address - Fax:
Practice Address - Street 1:5110 W 24TH ST
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-2948
Practice Address - Country:US
Practice Address - Phone:708-863-4856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.004899235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01118653OtherAMERICAN SPEECH-LANGUAGE HEARING ASSOCIATION
IL146-004899OtherDEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION