Provider Demographics
NPI:1295846707
Name:WARD, MARY FRITZSCHE
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:FRITZSCHE
Last Name:WARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:FRITZSCHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8001 LINCOLN AVE
Mailing Address - Street 2:8TH FLOOR
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-3695
Mailing Address - Country:US
Mailing Address - Phone:770-325-0319
Mailing Address - Fax:866-386-9429
Practice Address - Street 1:1480 RECKINGER RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-1624
Practice Address - Country:US
Practice Address - Phone:630-299-7590
Practice Address - Fax:630-299-7591
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-000821235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist