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General NPI Number Information
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NPI Number | 1669835856
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Entity Type | Individual
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Provider Name | ELIZABETH LIDOV M.A. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 04/04/2016
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Last Update Date | 01/15/2019
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Provider Practice Location Address
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Address Line | 10 W PHILLIP RD STE 108
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City | VERNON HILLS
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State | IL
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Zip | 60061-1730
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Country | US
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Telephone | 847-275-4115
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Fax |
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Provider Business Mailing Address
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Address Line | 790 NORTH AVE
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-1351
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Country | US
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Telephone |
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Fax |
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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 | 146014621
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 10525
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License Number State | CA
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