Provider Demographics
NPI:1104952159
Name:NATHANSON, BARBARA ILENE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:ILENE
Last Name:NATHANSON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8909 MENARD AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-2464
Mailing Address - Country:US
Mailing Address - Phone:847-989-1881
Mailing Address - Fax:847-329-0650
Practice Address - Street 1:64 OLD ORCHARD CENTERSUITE 524
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077
Practice Address - Country:US
Practice Address - Phone:847-989-1881
Practice Address - Fax:847-329-0650
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist