Provider Demographics
NPI:1477628378
Name:BLOCK, EVELYN SUE
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:SUE
Last Name:BLOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3043 WEST SHERWIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645
Mailing Address - Country:US
Mailing Address - Phone:773-262-7260
Mailing Address - Fax:773-262-7260
Practice Address - Street 1:3043 WEST SHERWIN AVENUE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645
Practice Address - Country:US
Practice Address - Phone:773-262-7260
Practice Address - Fax:773-262-7260
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist