Provider Demographics
NPI:1316937345
Name:NANCY A. CONGDON, M.S., P.C.
Entity type:Organization
Organization Name:NANCY A. CONGDON, M.S., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:CONGDON
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:630-963-6161
Mailing Address - Street 1:6800 MAIN ST
Mailing Address - Street 2:#114
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-3493
Mailing Address - Country:US
Mailing Address - Phone:630-963-6161
Mailing Address - Fax:630-963-6162
Practice Address - Street 1:6800 MAIN ST
Practice Address - Street 2:#114
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-3493
Practice Address - Country:US
Practice Address - Phone:630-963-6161
Practice Address - Fax:630-963-6162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-21
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147-000020231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL382608705001Medicaid
207275Medicare PIN