Provider Demographics
NPI:1669489332
Name:SIEGFORT, ELIZABETH E (MS, CCC/SLP/L)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:E
Last Name:SIEGFORT
Suffix:
Gender:F
Credentials:MS, CCC/SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:488 SPRING DR
Mailing Address - Street 2:
Mailing Address - City:MARENGO
Mailing Address - State:IL
Mailing Address - Zip Code:60152-3311
Mailing Address - Country:US
Mailing Address - Phone:847-366-8205
Mailing Address - Fax:815-568-8851
Practice Address - Street 1:488 SPRING DR
Practice Address - Street 2:
Practice Address - City:MARENGO
Practice Address - State:IL
Practice Address - Zip Code:60152-3311
Practice Address - Country:US
Practice Address - Phone:847-366-8205
Practice Address - Fax:815-568-8851
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
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
IL05632188OtherBLUE CROSS BLUE SHIELD