Provider Demographics
NPI:1639232887
Name:LIGHTBODY, TERRI B (AUD CCCA)
Entity Type:Individual
Prefix:DR
First Name:TERRI
Middle Name:B
Last Name:LIGHTBODY
Suffix:
Gender:F
Credentials:AUD CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 E LOOP ROAD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187
Mailing Address - Country:US
Mailing Address - Phone:630-580-5777
Mailing Address - Fax:630-580-5778
Practice Address - Street 1:55 E LOOP ROAD
Practice Address - Street 2:SUITE 204
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187
Practice Address - Country:US
Practice Address - Phone:630-580-5777
Practice Address - Fax:630-580-5778
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147000562231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK09542Medicare ID - Type Unspecified
Q23468Medicare UPIN