Healthcare Provider Details

I. General information

NPI: 1649481136
Provider Name (Legal Business Name): MS. ANCILLA LOUISE PARDUCCI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 41ST ST
MOLINE IL
61265-4501
US

IV. Provider business mailing address

1930 41ST ST
MOLINE IL
61265-4501
US

V. Phone/Fax

Practice location:
  • Phone: 309-558-9223
  • Fax: 309-797-5526
Mailing address:
  • Phone: 309-558-9223
  • Fax: 309-797-5526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146.015119
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License NumberAP99990804P
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: