Provider Demographics
NPI:1912037839
Name:MICHALAK, JILL RAE (BC-HID)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:RAE
Last Name:MICHALAK
Suffix:
Gender:F
Credentials:BC-HID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFITH
Mailing Address - State:IN
Mailing Address - Zip Code:46319-2806
Mailing Address - Country:US
Mailing Address - Phone:219-838-6659
Mailing Address - Fax:
Practice Address - Street 1:6555 WILLOW SPRINGS RD
Practice Address - Street 2:SUITE 11
Practice Address - City:LA GRANGE HIGHLANDS
Practice Address - State:IL
Practice Address - Zip Code:60525-4591
Practice Address - Country:US
Practice Address - Phone:708-579-9458
Practice Address - Fax:708-579-9561
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2830231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633818OtherBLUE CROSS BLUE SHIELD