1255491353 NPI number — LILLI A SHEMBOR BISHOP M.A., C.C.C.

Table of content: LILLI A SHEMBOR BISHOP M.A., C.C.C. (NPI 1255491353)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255491353 NPI number — LILLI A SHEMBOR BISHOP M.A., C.C.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHEMBOR BISHOP
Provider First Name:
LILLI
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A., C.C.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHEMBOR
Provider Other First Name:
LILLI
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A., C.C.C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255491353
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
134 BUENA VISTA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEKALB
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60115-1013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-753-6521
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1LUCINDA AVENUE
Provider Second Line Business Practice Location Address:
NORTHERN ILLINOIS UNIV., SPEECH-LANGUAGE-HEARING CLINIC
Provider Business Practice Location Address City Name:
DEKALB
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60115-2899
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-753-6521
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/11/2006

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:  146002905 , 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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