Provider Demographics
NPI:1518095041
Name:WANGLER, MAUREEN KATHERINE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:KATHERINE
Last Name:WANGLER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 W SUNNYSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5907
Mailing Address - Country:US
Mailing Address - Phone:773-456-1804
Mailing Address - Fax:
Practice Address - Street 1:1619 W SUNNYSIDE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5907
Practice Address - Country:US
Practice Address - Phone:773-456-1804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.006718235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1635015OtherBLUE CROSS BLUE SHIELD