1033245881 NPI number — MCCABE SPEECH AND LANGUAGE SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033245881 NPI number — MCCABE SPEECH AND LANGUAGE SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCCABE SPEECH AND LANGUAGE SERVICES
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:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033245881
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/11/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1740 RIDGE AVE
Provider Second Line Business Mailing Address:
LL11B
Provider Business Mailing Address City Name:
EVANSTON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60201-5918
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-869-2615
Provider Business Mailing Address Fax Number:
847-869-4881

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1740 RIDGE AVE
Provider Second Line Business Practice Location Address:
LL11B
Provider Business Practice Location Address City Name:
EVANSTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60201-5918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-869-2615
Provider Business Practice Location Address Fax Number:
847-869-4881
Provider Enumeration Date:
02/26/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCCABE
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
NEWELL
Authorized Official Title or Position:
SPEECH-LANGUAGE PATHOLOGIST,OWNER
Authorized Official Telephone Number:
847-869-2615

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , 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: 1634951 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".