Provider Demographics
NPI:1215060314
Name:NORTHWEST SPEECH AND HEARING CENTER LTD.
Entity type:Organization
Organization Name:NORTHWEST SPEECH AND HEARING CENTER LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:CHISHOLM
Authorized Official - Suffix:
Authorized Official - Credentials:AUD, CCC-A
Authorized Official - Phone:847-392-2250
Mailing Address - Street 1:880 W CENTRAL RD STE 4300
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2381
Mailing Address - Country:US
Mailing Address - Phone:847-392-2250
Mailing Address - Fax:847-392-2204
Practice Address - Street 1:880 W CENTRAL RD STE 4300
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2381
Practice Address - Country:US
Practice Address - Phone:847-392-2250
Practice Address - Fax:847-392-2204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology PractitionerGroup - Single Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL771980Medicare ID - Type UnspecifiedMEDICARE GROUP NO.