Provider Demographics
NPI:1760717029
Name:FOERTSCH, MAUREEN M
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:M
Last Name:FOERTSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MAUREEN
Other - Middle Name:BODNAR
Other - Last Name:FOERTSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17310 LATHROP AVE
Mailing Address - Street 2:
Mailing Address - City:EAST HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429
Mailing Address - Country:US
Mailing Address - Phone:708-912-6991
Mailing Address - Fax:708-960-4965
Practice Address - Street 1:17310 LATHROP AVE
Practice Address - Street 2:
Practice Address - City:EAST HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429
Practice Address - Country:US
Practice Address - Phone:708-912-6991
Practice Address - Fax:708-960-4965
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist