Provider Demographics
NPI:1164679973
Name:RAMSEY, DANA (AUD)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:
Last Name:RAMSEY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 S MILWAUKEE AVE
Mailing Address - Street 2:UNIT B
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3235
Mailing Address - Country:US
Mailing Address - Phone:708-638-4256
Mailing Address - Fax:
Practice Address - Street 1:606 S MILWAUKEE AVE
Practice Address - Street 2:UNIT B
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3235
Practice Address - Country:US
Practice Address - Phone:708-638-4256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147001281231H00000X, 231HA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$01Medicaid