1649309766 NPI number — MRS. WENDY SUE PERLIN M.A.C.C.C. SLP

Table of content: MRS. WENDY SUE PERLIN M.A.C.C.C. SLP (NPI 1649309766)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649309766 NPI number — MRS. WENDY SUE PERLIN M.A.C.C.C. SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERLIN
Provider First Name:
WENDY
Provider Middle Name:
SUE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A.C.C.C. SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649309766
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21378 PRESCOTT CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KILDEER
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60047-8859
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-842-4057
Provider Business Mailing Address Fax Number:
847-842-4059

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1025 OLD MCHENRY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE ZURICH
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60047-8428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-842-4057
Provider Business Practice Location Address Fax Number:
847-842-4059
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  146000639 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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