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General NPI Number Information
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NPI Number | 1336798255
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Entity Type | Individual
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Provider Name | RENEE ROSENBERG CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 09/04/2019
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Last Update Date | 09/04/2019
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Provider Practice Location Address
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Address Line | C/O EAST PRAIRIE SCHOOL 7616 N. EAST PRAIRIE ROAD
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City | SKOKE
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State | IL
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Zip | 60076
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Country | US
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Telephone | 847-673-1141
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Fax | 847-673-1186
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Provider Business Mailing Address
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Address Line | C/O EAST PRAIRIE SCHOOL 7616 N. EAST PRAIRIE ROAD
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City | SKOKIE
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State | IL
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Zip | 60076
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Country | US
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Telephone | 847-673-1141
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Fax | 847-673-1186
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 146-001921
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License Number State | IL
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