Provider Demographics
NPI:1689897704
Name:BADOFSKY, ELLEN R (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:R
Last Name:BADOFSKY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
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Mailing Address - Street 1:9429 KARLOV AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1416
Mailing Address - Country:US
Mailing Address - Phone:847-322-9155
Mailing Address - Fax:847-676-8424
Practice Address - Street 1:1718 SHERMAN AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-5608
Practice Address - Country:US
Practice Address - Phone:847-322-9155
Practice Address - Fax:847-676-8424
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist