Provider Demographics
NPI:1104943331
Name:DEPALMA, JANET L (AUD)
Entity type:Individual
Prefix:DR
First Name:JANET
Middle Name:L
Last Name:DEPALMA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1047 W STONE CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-1939
Mailing Address - Country:US
Mailing Address - Phone:815-459-2559
Mailing Address - Fax:
Practice Address - Street 1:435 N MULFORD RD
Practice Address - Street 2:SUITE #10A
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5189
Practice Address - Country:US
Practice Address - Phone:815-399-5279
Practice Address - Fax:815-399-3764
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147-000168231HA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$01Medicaid
IL212197001Medicare PIN
IL$$$$$$$$$01Medicaid