Provider Demographics
NPI:1619021359
Name:CHILDRENS MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:CHILDRENS MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PEDIATRIC AUDIOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:G
Authorized Official - Last Name:OTWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MSCCA
Authorized Official - Phone:773-975-8650
Mailing Address - Street 1:2300 N CHILDRENS PLZ
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3363
Mailing Address - Country:US
Mailing Address - Phone:773-880-4530
Mailing Address - Fax:773-880-6618
Practice Address - Street 1:2731 HARRISON ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1215
Practice Address - Country:US
Practice Address - Phone:847-425-9404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147.000686282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren