Provider Demographics
NPI:1073064044
Name:UNIVERSITY OF ILLINOIS DEPARTMENT OF SPEECH & HEARING SCIENCE
Entity type:Organization
Organization Name:UNIVERSITY OF ILLINOIS DEPARTMENT OF SPEECH & HEARING SCIENCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LOU
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:217-333-2230
Mailing Address - Street 1:901 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-6206
Mailing Address - Country:US
Mailing Address - Phone:217-333-2230
Mailing Address - Fax:217-244-2235
Practice Address - Street 1:901 S 6TH ST
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-6206
Practice Address - Country:US
Practice Address - Phone:217-333-2230
Practice Address - Fax:217-244-2235
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF ILLINOIS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-14
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty