Healthcare Provider Details

I. General information

NPI: 1356925614
Provider Name (Legal Business Name): BRADI O'ROURKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 05/11/2021
Certification Date: 04/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13242 S ROUTE 59 # 52
PLAINFIELD IL
60585-5443
US

IV. Provider business mailing address

25011 VERMETTE RD
PLAINFIELD IL
60585-7731
US

V. Phone/Fax

Practice location:
  • Phone: 815-260-6596
  • Fax:
Mailing address:
  • Phone: 815-212-7162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: