Provider Demographics
NPI:1558401661
Name:REISER, TRUDE MARGARET (MA CCCA)
Entity Type:Individual
Prefix:MRS
First Name:TRUDE
Middle Name:MARGARET
Last Name:REISER
Suffix:
Gender:F
Credentials:MA CCCA
Other - Prefix:MRS
Other - First Name:GERTRUDE
Other - Middle Name:
Other - Last Name:REISER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA CCCA
Mailing Address - Street 1:300 E WAR MEMORIAL DRIVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-7551
Mailing Address - Country:US
Mailing Address - Phone:309-686-7250
Mailing Address - Fax:309-686-7788
Practice Address - Street 1:300 E WAR MEMORIAL DRIVE
Practice Address - Street 2:SUITE 202
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-7551
Practice Address - Country:US
Practice Address - Phone:309-686-7250
Practice Address - Fax:309-686-7788
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL68231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL002134637001OtherCATERPILLAR
IL07215173OtherBLUE CROSS BLUE SHIELD