Provider Demographics
NPI:1033234992
Name:SUSAN VORWERK MAT CCC SLP SPEECH & LANGUAGE PATHOLOGY SERVICES PC
Entity Type:Organization
Organization Name:SUSAN VORWERK MAT CCC SLP SPEECH & LANGUAGE PATHOLOGY SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN JANE RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:VORWERK
Authorized Official - Suffix:
Authorized Official - Credentials:MAT CCC SLP
Authorized Official - Phone:708-799-7900
Mailing Address - Street 1:3235 VOLLMER RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-2013
Mailing Address - Country:US
Mailing Address - Phone:708-799-7900
Mailing Address - Fax:708-799-7977
Practice Address - Street 1:3235 VOLLMER RD
Practice Address - Street 2:SUITE 104
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2013
Practice Address - Country:US
Practice Address - Phone:708-799-7900
Practice Address - Fax:708-799-7977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146000355235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01607161OtherBLUE CROSS BLUE SHIELD OF