Provider Demographics
NPI:1922243286
Name:D'AVOLA, ROSINA A (MS, CCC-SLP/L)
Entity type:Individual
Prefix:
First Name:ROSINA
Middle Name:A
Last Name:D'AVOLA
Suffix:
Gender:F
Credentials:MS, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N FOXDALE DR
Mailing Address - Street 2:#209
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-5500
Mailing Address - Country:US
Mailing Address - Phone:847-809-2020
Mailing Address - Fax:
Practice Address - Street 1:1200 N FOXDALE DR
Practice Address - Street 2:#209
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-5500
Practice Address - Country:US
Practice Address - Phone:847-809-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-15
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146009443235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist