PAIGE DANIELLE FORMSMA Speech-Language Pathologist License verification

Business Entity

NOT RENEWED

License Type

Speech-Language Pathologist

Description

LICENSED AUDIOLOGIST

License Number

147001519

License Status

NOT RENEWED

Business

First Name

PAIGE

Middle

DANIELLE

Last Name

FORMSMA

Business Name

PAIGE DANIELLE FORMSMA

Original Issue Date

08/26/2014

Effective Date

09/30/2015

Expiration Date

10/31/2017

City

CHICAGO

State

Zip

60642

County

COOK

Ever Disciplined

LastModifiedDate

01/04/2018