1689897704 NPI number — MRS. ELLEN R BADOFSKY MA, CCC-SLP

Table of content: DR. MOHAN MATHEW JOHN M.B.B.S. (NPI 1346522463)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689897704 NPI number — MRS. ELLEN R BADOFSKY MA, CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BADOFSKY
Provider First Name:
ELLEN
Provider Middle Name:
R
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, CCC-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:
1689897704
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:
9429 KARLOV AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SKOKIE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60076-1416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-322-9155
Provider Business Mailing Address Fax Number:
847-676-8424

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1718 SHERMAN AVE
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
EVANSTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60201-5608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-322-9155
Provider Business Practice Location Address Fax Number:
847-676-8424
Provider Enumeration Date:
04/10/2007

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 , 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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