SAMANTHA RENEE FORMENTO Speech-Language Pathologist License verification

Business Entity

EXPIRED

License Type

Speech-Language Pathologist

Description

LICENSED SPEECH LANGUAGE PATHOLOGY TEMPORARY

License Number

242004617

License Status

EXPIRED

Business

First Name

SAMANTHA

Middle

RENEE

Last Name

FORMENTO

Business Name

SAMANTHA RENEE FORMENTO

Original Issue Date

08/04/2017

Effective Date

08/04/2017

Expiration Date

08/04/2018

City

GLEN ELLYN

State

Zip

60137

County

DUPAGE

Ever Disciplined

LastModifiedDate

12/04/2018