Individual ProviderMaxwel DomanSpeech-Language PathologistSpeech, Language and Hearing Service ProvidersPractice Address2130 W Chicago Ave Apt 3f, Chicago, IL 60622-4217(708) 369-7169PECOS EnrollmentBased on the most recent information from CMS, provider Maxwel Doman does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1497526339Provider TypeIndividualFull NameDoman, MaxwelCredentialCCC-SLPGenderMaleSole ProprietorYesEnumeration Date1/10/2024Last Updated11/20/2024Contact InformationPractice LocationPractice Address2130 W Chicago Ave Apt 3f, Chicago, IL 60622-4217Phone(708) 369-7169FaxUnlisted FaxMailing LocationMailing Address2130 W Chicago Ave Apt 3f, Chicago, IL 60622-4217Phone(708) 369-7169FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode235Z00000XPrimaryDescriptionSpeech-Language PathologistSpeech, Language and Hearing Service ProvidersLicense146014254Illinois