Provider Demographics
NPI:1407916836
Name:NORTHERN ILLINOIS UNIVERSITY
Entity Type:Organization
Organization Name:NORTHERN ILLINOIS UNIVERSITY
Other - Org Name:SPEECH LANGUAGE HEARING CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT TO THE DEAN
Authorized Official - Prefix:
Authorized Official - First Name:CARISSA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-753-6161
Mailing Address - Street 1:3100 SYCAMORE RD
Mailing Address - Street 2:NIU SPEECH LANGUAGE HEARING CLINIC
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-9621
Mailing Address - Country:US
Mailing Address - Phone:815-753-1481
Mailing Address - Fax:815-753-1664
Practice Address - Street 1:3100 SYCAMORE RD
Practice Address - Street 2:NIU SPEECH LANGUAGE HEARING CLINIC
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-9621
Practice Address - Country:US
Practice Address - Phone:815-753-1481
Practice Address - Fax:815-753-1664
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHERN ILLINOIS UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-08
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL1727Medicare PIN