Healthcare Provider Details

I. General information

NPI: 1023354776
Provider Name (Legal Business Name): LOIS HOLMES VATCH M.A./CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2012
Last Update Date: 12/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3470 N ALPINE RD
ROCKFORD IL
61114-4802
US

IV. Provider business mailing address

32550 PEARL ST
KIRKLAND IL
60146-8424
US

V. Phone/Fax

Practice location:
  • Phone: 815-639-1015
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146004694
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: