Provider Demographics
NPI:1114170065
Name:TREDE, SUSAN ALLYSON (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ALLYSON
Last Name:TREDE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ALLYSON
Other - Last Name:WIENKE-TREDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:326 TERWILLIGER AVE
Mailing Address - Street 2:
Mailing Address - City:HAMPSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60140-9625
Mailing Address - Country:US
Mailing Address - Phone:847-683-3770
Mailing Address - Fax:
Practice Address - Street 1:1 LUCINDA AVENUE
Practice Address - Street 2:NORTHERN ILLINOIS UNIV.,SPEECH-LANGUAGE HEARING CLINIC
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-2899
Practice Address - Country:US
Practice Address - Phone:815-753-1481
Practice Address - Fax:815-753-1664
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-23
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146002662235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist