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General NPI Number Information
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NPI Number | 1497988521
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Entity Type | Organization
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Legal Business Name | COLLEEN NITSCHE, LTD
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Dates
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Enumeration Date | 08/24/2009
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Last Update Date | 08/24/2009
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Provider Practice Location Address
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Address Line | 10055 S ARTESIAN AVE
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City | CHICAGO
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State | IL
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Zip | 60655-1053
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Country | US
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Telephone | 773-615-8296
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Fax | 773-238-3334
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Provider Business Mailing Address
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Address Line | 10055 S ARTESIAN AVE
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City | CHICAGO
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State | IL
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Zip | 60655-1053
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Country | US
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Telephone | 773-615-8296
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Fax | 773-238-3334
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Authorized Official
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Title or Position | OWNER
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Name | COLLEEN NITSCHE
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Credential | SLP
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Telephone | 773-615-8296
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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 | 146004836
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License Number State | IL
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