Provider Demographics
NPI:1548219454
Name:ANTONOPOULOS, VASILIKITSA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:VASILIKITSA
Middle Name:
Last Name:ANTONOPOULOS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 N STATE ST
Mailing Address - Street 2:2E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-8665
Mailing Address - Country:US
Mailing Address - Phone:773-206-7997
Mailing Address - Fax:312-787-6371
Practice Address - Street 1:850 N STATE ST
Practice Address - Street 2:2E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-8665
Practice Address - Country:US
Practice Address - Phone:773-206-7997
Practice Address - Fax:312-787-6371
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146008154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01635560OtherBLUE CROSS BLUE SHIELD