Provider Demographics
NPI:1053608562
Name:GALAWAY-EDEN, MAURINE J
Entity type:Individual
Prefix:
First Name:MAURINE
Middle Name:J
Last Name:GALAWAY-EDEN
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 1:3252 KNOX DR
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-4422
Mailing Address - Country:US
Mailing Address - Phone:815-233-3252
Mailing Address - Fax:
Practice Address - Street 1:3252 KNOX DR
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-4422
Practice Address - Country:US
Practice Address - Phone:815-233-3252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.010608235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist