Provider Demographics
NPI:1457801664
Name:CENTER FOR AUDIOLOGY, SPEECH, LANGUAGE, AND LEARNING
Entity type:Organization
Organization Name:CENTER FOR AUDIOLOGY, SPEECH, LANGUAGE, AND LEARNING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:EISENHAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP, MBA
Authorized Official - Phone:847-491-2491
Mailing Address - Street 1:2315 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60208-0897
Mailing Address - Country:US
Mailing Address - Phone:847-467-1198
Mailing Address - Fax:
Practice Address - Street 1:2315 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60208-0897
Practice Address - Country:US
Practice Address - Phone:847-467-1198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWESTERN UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009402261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center