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General NPI Number Information
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NPI Number | 1730968728
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Entity Type | Individual
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Provider Name | ELIZABETH DIMATTEO
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Gender | Female
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Dates
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Enumeration Date | 09/27/2023
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Last Update Date | 10/09/2023
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Provider Practice Location Address
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Address Line | 1001 S FAIRVIEW AVE
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City | PARK RIDGE
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State | IL
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Zip | 60068-4712
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Country | US
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Telephone | 847-318-4235
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Fax |
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Provider Business Mailing Address
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Address Line | 360 W HUBBARD ST APT 1008
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City | CHICAGO
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State | IL
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Zip | 60654-5748
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Country | US
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Telephone | 847-224-7199
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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 | 146.015680
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License Number State | IL
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