Provider Demographics
NPI:1235341926
Name:REHAB ADVANTAGE, INC
Entity Type:Organization
Organization Name:REHAB ADVANTAGE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:ELY
Authorized Official - Suffix:
Authorized Official - Credentials:MHS CCC SLP
Authorized Official - Phone:708-309-5459
Mailing Address - Street 1:14425 KILDARE AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:IL
Mailing Address - Zip Code:60445-2649
Mailing Address - Country:US
Mailing Address - Phone:708-309-5459
Mailing Address - Fax:708-597-5422
Practice Address - Street 1:14425 KILDARE AVE
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:IL
Practice Address - Zip Code:60445-2649
Practice Address - Country:US
Practice Address - Phone:708-309-5459
Practice Address - Fax:708-597-5422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001632676OtherBLUE CROSS BLUE SHIELD