Provider Demographics
NPI:1497988521
Name:COLLEEN NITSCHE, LTD
Entity Type:Organization
Organization Name:COLLEEN NITSCHE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NITSCHE
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:773-615-8296
Mailing Address - Street 1:10055 S ARTESIAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-1053
Mailing Address - Country:US
Mailing Address - Phone:773-615-8296
Mailing Address - Fax:773-238-3334
Practice Address - Street 1:10055 S ARTESIAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-1053
Practice Address - Country:US
Practice Address - Phone:773-615-8296
Practice Address - Fax:773-238-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146004836235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty