Healthcare Provider Details

I. General information

NPI: 1114951274
Provider Name (Legal Business Name): BONNIE GAIL MELTZER SLP, CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 COBBLEWOOD DR
NORTHBROOK IL
60062-7619
US

IV. Provider business mailing address

2510 COBBLEWOOD DR
NORTHBROOK IL
60062-7619
US

V. Phone/Fax

Practice location:
  • Phone: 847-564-4062
  • Fax: 847-564-4266
Mailing address:
  • Phone: 847-564-4062
  • Fax: 847-564-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146-001472
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License NumberBM43941201P
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: