Healthcare Provider Details

I. General information

NPI: 1861919532
Provider Name (Legal Business Name): MRS. MARLA KAY BARTMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 08/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 WINSTON DR
BOLINGBROOK IL
60440-1300
US

IV. Provider business mailing address

508 S ASHLAND AVE
LA GRANGE IL
60525-2811
US

V. Phone/Fax

Practice location:
  • Phone: 630-739-0185
  • Fax:
Mailing address:
  • Phone: 708-352-4367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: