Healthcare Provider Details

I. General information

NPI: 1407929326
Provider Name (Legal Business Name): SUSAN M SMITH AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 04/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1S450 SUMMIT
OAKBROOK TERRACE IL
60181
US

IV. Provider business mailing address

172 SCHILLER
ELMHURST IL
60126-2885
US

V. Phone/Fax

Practice location:
  • Phone: 630-792-9300
  • Fax: 630-792-0902
Mailing address:
  • Phone: 630-993-5676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147.000234
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147-000234
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number147000234
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number147000234
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: