Provider Demographics
NPI:1972021285
Name:WEIL, EMILY J
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:J
Last Name:WEIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60145-8266
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1011 BONUS AVE
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-2343
Practice Address - Country:US
Practice Address - Phone:815-547-4527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.002994235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01036206OtherAMERICAN SPEECH-LANGUAGE HEARING ASSOCIATION
IL146.002994OtherILLINOIS DEPT OF FINANCIAL AND PROFESSIONAL REGULATION
IL2088765OtherSTATE TEACHER CERTIFICATE FOR SCHOOL SERVICE PERSONNEL