Provider Demographics
NPI:1497952147
Name:MICHAEL, LITSA G
Entity Type:Individual
Prefix:
First Name:LITSA
Middle Name:G
Last Name:MICHAEL
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 1:270 ILLINOIS BLVD
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-3317
Mailing Address - Country:US
Mailing Address - Phone:847-882-8695
Mailing Address - Fax:630-773-0455
Practice Address - Street 1:270 ILLINOIS BLVD
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-3317
Practice Address - Country:US
Practice Address - Phone:847-882-8695
Practice Address - Fax:630-773-0455
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
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