Provider Demographics
NPI:1841702693
Name:RUMMELHART, PATRICIA DESELM
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:DESELM
Last Name:RUMMELHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 E PINE AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-2252
Mailing Address - Country:US
Mailing Address - Phone:630-894-0490
Mailing Address - Fax:
Practice Address - Street 1:560 PINECROFT DR
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-2564
Practice Address - Country:US
Practice Address - Phone:630-529-1883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-00-1857235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist