Provider Demographics
NPI:1154884765
Name:EHRHARDT, ANNELISE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANNELISE
Middle Name:
Last Name:EHRHARDT
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3914 N CLAREMONT AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3820
Mailing Address - Country:US
Mailing Address - Phone:630-464-7806
Mailing Address - Fax:
Practice Address - Street 1:1775 BLANCHARD RD
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60087-3014
Practice Address - Country:US
Practice Address - Phone:224-303-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist