Provider Demographics
NPI:1801014832
Name:ZEREBNY, ROMAN (MA CCC-A)
Entity Type:Individual
Prefix:MR
First Name:ROMAN
Middle Name:
Last Name:ZEREBNY
Suffix:
Gender:M
Credentials:MA CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 WESTGATE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-6162
Mailing Address - Country:US
Mailing Address - Phone:815-229-2880
Mailing Address - Fax:815-229-2159
Practice Address - Street 1:3615 WESTGATE PARKWAY
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-6162
Practice Address - Country:US
Practice Address - Phone:815-229-2880
Practice Address - Fax:815-229-2159
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL557440Medicare ID - Type Unspecified