Provider Demographics
NPI:1659594257
Name:REICHERT, MARIA D (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:D
Last Name:REICHERT
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 1:10 STORY BOOK LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLNSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60069-3231
Mailing Address - Country:US
Mailing Address - Phone:847-226-8180
Mailing Address - Fax:
Practice Address - Street 1:10 STORY BOOK LN
Practice Address - Street 2:
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069-3231
Practice Address - Country:US
Practice Address - Phone:847-226-8180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04932601OtherBCBS OF ILLINOIS