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General NPI Number Information
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NPI Number | 1457801664
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Entity Type | Organization
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Legal Business Name | CENTER FOR AUDIOLOGY, SPEECH, LANGUAGE, AND LEARNING
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Dates
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Enumeration Date | 10/12/2016
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Last Update Date | 10/12/2016
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Provider Practice Location Address
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Address Line | 2315 CAMPUS DR
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City | EVANSTON
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State | IL
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Zip | 60208-0897
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Country | US
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Telephone | 847-467-1198
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Fax |
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Provider Business Mailing Address
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Address Line | 2315 CAMPUS DR
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City | EVANSTON
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State | IL
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Zip | 60208-0897
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Country | US
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Telephone | 847-467-1198
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DENISE EISENHAUER
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Credential | MS, CCC-SLP, MBA
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Telephone | 847-491-2491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 071009402
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License Number State | IL
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