Provider Demographics
NPI:1437794005
Name:VIRTS, MAUREEN LOUISE (AUD)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:LOUISE
Last Name:VIRTS
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 1:5835 S COTTAGE GROVE AVE RM 4754
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1416
Mailing Address - Country:US
Mailing Address - Phone:773-795-0207
Mailing Address - Fax:773-834-0154
Practice Address - Street 1:5857 S MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1463
Practice Address - Country:US
Practice Address - Phone:773-795-0207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147001717231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist