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General NPI Number Information
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NPI Number | 1962655522
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Entity Type | Organization
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Legal Business Name | NORTHWESTERN ILLINOIS ASSOCIATION
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Dates
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Enumeration Date | 10/28/2008
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Last Update Date | 10/28/2008
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Provider Practice Location Address
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Address Line | 1895 BUNKER HILL RD
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City | DUBUQUE
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State | IA
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Zip | 52001-3004
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Country | US
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Telephone | 563-582-4387
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Fax |
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Provider Business Mailing Address
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Address Line | 245 W EXCHANGE ST
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City | SYCAMORE
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State | IL
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Zip | 60178-1495
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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 | COORDINATOR
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Name | JANE NEISENDORF
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Credential |
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Telephone | 815-895-9227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235500000X
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Taxonomy Name | Speech/Language/Hearing Specialist/Technologist
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License Number | 2252428
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License Number State | IL
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