Provider Demographics
NPI:1528135936
Name:SCHUPBACH, JOANNE ELIZABETH (MS, MA)
Entity type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:ELIZABETH
Last Name:SCHUPBACH
Suffix:
Gender:F
Credentials:MS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1653 W CONGRESS PKWY
Mailing Address - Street 2:ROOM 203 SENN
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3833
Mailing Address - Country:US
Mailing Address - Phone:312-942-3676
Mailing Address - Fax:
Practice Address - Street 1:1653 W CONGRESS PKWY
Practice Address - Street 2:ROOM 203 SENN
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3833
Practice Address - Country:US
Practice Address - Phone:312-942-3676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL231HA2500XMedicaid
IL231HA2400XMedicaid
IL231H00000XMedicaid
IL231H00000XMedicaid
2237600000XMedicare ID - Type Unspecified
231HA2400XMedicare ID - Type Unspecified
231HA2500XMedicare ID - Type Unspecified
IL231HA2400XMedicare UPIN
IL231HA2400XMedicaid