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NPI Code Detail

MEDICARE: CRYSTAL MARIE VANDERVEEN SLP

MEDICARE: CRYSTAL MARIE VANDERVEEN SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist146007440IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
109932114OTHERILBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1215068507
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTAL MARIE VANDERVEEN SLP
Provider Business Mailing Address
First Line : 19000 HALSTED ST
Second Line :
City : HOMEWOOD
State : IL
Zip : 60430-4204
Country : US
Telephone Number : 708-957-9200
Fax Number :
Provider Business Practice Location Address
First Line : 19000 HALSTED ST
Second Line :
City : HOMEWOOD
State : IL
Zip : 60430-4204
Country : US
Telephone Number : 708-957-9200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2007
Last Update Date : 02/18/2022

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Directions to “ CRYSTAL MARIE VANDERVEEN SLP” Practice Location

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