1033234992 NPI number — SUSAN VORWERK MAT CCC SLP SPEECH & LANGUAGE PATHOLOGY SERVICES PC

Table of content: (NPI 1033234992)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033234992 NPI number — SUSAN VORWERK MAT CCC SLP SPEECH & LANGUAGE PATHOLOGY SERVICES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUSAN VORWERK MAT CCC SLP SPEECH & LANGUAGE PATHOLOGY SERVICES PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1033234992
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3235 VOLLMER RD
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
FLOSSMOOR
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60422-2013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-799-7900
Provider Business Mailing Address Fax Number:
708-799-7977

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3235 VOLLMER RD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
FLOSSMOOR
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60422-2013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-799-7900
Provider Business Practice Location Address Fax Number:
708-799-7977
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VORWERK
Authorized Official First Name:
SUSAN JANE RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
708-799-7900

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  146000355 , 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)

  • Identifier: 01607161 . This is a "BLUE CROSS BLUE SHIELD OF" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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