Healthcare Provider Details

I. General information

NPI: 1811483456
Provider Name (Legal Business Name): EMILY ROSE REZEK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2018
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 SEMINARY AVE
AURORA IL
60505-4768
US

IV. Provider business mailing address

710 CORNELL DR
OSWEGO IL
60543-8670
US

V. Phone/Fax

Practice location:
  • Phone: 630-299-5550
  • Fax:
Mailing address:
  • Phone: 708-698-1856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146.014328
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: