Healthcare Provider Details

I. General information

NPI: 1336794668
Provider Name (Legal Business Name): BETTY L MISKEVICH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 SHERWOOD DR STE 201
LAKE BLUFF IL
60044-2235
US

IV. Provider business mailing address

2605 N GREENWOOD AVE
ARLINGTON HEIGHTS IL
60004-8430
US

V. Phone/Fax

Practice location:
  • Phone: 877-486-4140
  • Fax:
Mailing address:
  • Phone: 630-261-5751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number242.005408
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: