Provider Demographics
NPI:1871774745
Name:CHILCUTT, VIRGINIA DIANE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:DIANE
Last Name:CHILCUTT
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16849 BURR OAK DR
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-8497
Mailing Address - Country:US
Mailing Address - Phone:815-463-9010
Mailing Address - Fax:815-463-9014
Practice Address - Street 1:16849 BURR OAK DR
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-8497
Practice Address - Country:US
Practice Address - Phone:815-463-9010
Practice Address - Fax:815-463-9014
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist