Provider Demographics
NPI:1528296944
Name:BISHIR, SHANE ERIK (MA,CCC-SLP/L)
Entity type:Individual
Prefix:MR
First Name:SHANE
Middle Name:ERIK
Last Name:BISHIR
Suffix:
Gender:M
Credentials:MA,CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2054 MIDDLEBURY DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60503-5442
Mailing Address - Country:US
Mailing Address - Phone:630-898-7080
Mailing Address - Fax:
Practice Address - Street 1:1245 CORPORATE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-7607
Practice Address - Country:US
Practice Address - Phone:630-898-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-006058235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09128403OtherAMERICAN SPEECH-LANGUAGE HEARING ASSOCIATION
IL146-006058OtherILLINOIS DEPARTMENT OF PROFESSIONAL REGULATION