Provider Demographics
NPI:1073376083
Name:BARDACH, MARIE B
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:B
Last Name:BARDACH
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 1:2020 SAINT REGIS DR APT 202
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4927
Mailing Address - Country:US
Mailing Address - Phone:708-557-8424
Mailing Address - Fax:
Practice Address - Street 1:2020 SAINT REGIS DR APT 202
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4927
Practice Address - Country:US
Practice Address - Phone:708-557-8424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL217.0002892355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant