Healthcare Provider Details

I. General information

NPI: 1669489332
Provider Name (Legal Business Name): ELIZABETH E SIEGFORT M.S., CCC/SLP/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 SPRING DR
MARENGO IL
60152-3311
US

IV. Provider business mailing address

488 SPRING DR
MARENGO IL
60152-3311
US

V. Phone/Fax

Practice location:
  • Phone: 847-366-8205
  • Fax: 815-568-8851
Mailing address:
  • Phone: 847-366-8205
  • Fax: 815-568-8851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: