Provider Demographics
NPI:1619312576
Name:PODVRSAN, MAUREEN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:PODVRSAN
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 1:4160 IL ROUTE 83
Mailing Address - Street 2:SUITE 304
Mailing Address - City:LONG GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60047-8034
Mailing Address - Country:US
Mailing Address - Phone:847-821-1237
Mailing Address - Fax:847-276-2743
Practice Address - Street 1:4160 IL ROUTE 83
Practice Address - Street 2:SUITE 304
Practice Address - City:LONG GROVE
Practice Address - State:IL
Practice Address - Zip Code:60047-8034
Practice Address - Country:US
Practice Address - Phone:847-821-1237
Practice Address - Fax:847-276-2743
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.004735235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist