Healthcare Provider Details

I. General information

NPI: 1104953991
Provider Name (Legal Business Name): MARY RUBENACKER LANGAN DT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 BLACKBERRY TRL
AURORA IL
60506-4261
US

IV. Provider business mailing address

61 BLACKBERRY TRL
AURORA IL
60506-4261
US

V. Phone/Fax

Practice location:
  • Phone: 630-897-5443
  • Fax:
Mailing address:
  • Phone: 630-897-5443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License NumberML22820803P
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License NumberML22820803P
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: