Provider Demographics
NPI:1386813236
Name:CHURNOVIC, BRITTANY ROSE (MHS)
Entity type:Individual
Prefix:MISS
First Name:BRITTANY
Middle Name:ROSE
Last Name:CHURNOVIC
Suffix:
Gender:F
Credentials:MHS
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:ROSE
Other - Last Name:SHREFFLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 DRAKE AVE
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-4544
Mailing Address - Country:US
Mailing Address - Phone:815-685-7730
Mailing Address - Fax:
Practice Address - Street 1:923 KELLY AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-4648
Practice Address - Country:US
Practice Address - Phone:815-685-7730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146011900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist