Provider Demographics
NPI:1821167990
Name:SILVERTRUST, JOANNE ELLEN (MS)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:ELLEN
Last Name:SILVERTRUST
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-2204
Mailing Address - Country:US
Mailing Address - Phone:847-362-7559
Mailing Address - Fax:847-680-3350
Practice Address - Street 1:214 1ST ST
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-2204
Practice Address - Country:US
Practice Address - Phone:847-362-7559
Practice Address - Fax:847-680-3350
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
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
IL0004932312OtherBCBS