Provider Demographics
NPI:1952075798
Name:NORDSTROM, ALICIA KATHRYN (MS)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:KATHRYN
Last Name:NORDSTROM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:JANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14711 S RAVINIA AVE
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-3100
Mailing Address - Country:US
Mailing Address - Phone:708-787-0952
Mailing Address - Fax:708-787-0958
Practice Address - Street 1:14711 S RAVINIA AVE
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3100
Practice Address - Country:US
Practice Address - Phone:708-787-0952
Practice Address - Fax:708-787-0958
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist