Provider Demographics
NPI:1023185808
Name:IMHERR, ANN MARIE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANN MARIE
Middle Name:
Last Name:IMHERR
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:ANN MARIE
Other - Middle Name:
Other - Last Name:KUBEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2736 N HAMPDEN CT APT 105
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1635
Mailing Address - Country:US
Mailing Address - Phone:847-845-7516
Mailing Address - Fax:
Practice Address - Street 1:2736 N HAMPDEN CT APT 105
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1635
Practice Address - Country:US
Practice Address - Phone:847-845-7516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.008166235Z00000X
OK3682235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist