=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962656538
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SWEENEY, AUGUSTIN AND ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2008
-----------------------------------------------------
Last Update Date | 11/10/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5225 OLD ORCHARD RD
-----------------------------------------------------
City | SKOKIE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60077-4405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-583-9492
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5225 OLD ORCHARD RD
-----------------------------------------------------
City | SKOKIE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60077-4405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | DR. MAUREEN A. SWEENEY
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 847-583-9492
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0855X
-----------------------------------------------------
Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
-----------------------------------------------------
License Number | 149.000919
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QH0700X
-----------------------------------------------------
Taxonomy Name | Hearing and Speech Clinic/Center
-----------------------------------------------------
License Number | 146-003351
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------