Provider Demographics
NPI:1114013950
Name:UIC ASSISTIVE TECHNOLOGY UNIT
Entity Type:Organization
Organization Name:UIC ASSISTIVE TECHNOLOGY UNIT
Other - Org Name:ASSISTIVE TECHNOLOGY UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-413-7784
Mailing Address - Street 1:1640 WEST ROOSEVELT ROAD
Mailing Address - Street 2:MC 726
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608
Mailing Address - Country:US
Mailing Address - Phone:312-413-1555
Mailing Address - Fax:312-413-3709
Practice Address - Street 1:1640 WEST ROOSEVELT ROAD
Practice Address - Street 2:MC 726
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608
Practice Address - Country:US
Practice Address - Phone:312-413-1555
Practice Address - Fax:312-413-3709
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-05
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01621076OtherBLUE CROSS BLUE SHIELD #
IL=========012Medicaid
IL01621076OtherBLUE CROSS BLUE SHIELD #