Provider Demographics
NPI:1972847002
Name:NORTHWESTERN UNIVERSITY SLL CLINIC
Entity Type:Organization
Organization Name:NORTHWESTERN UNIVERSITY SLL CLINIC
Other - Org Name:NORTHWESTERN UNIVERSITY SPEECH-LANGUAGE-LEARNING CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSOCIATE CHAIR
Authorized Official - Prefix:PROF
Authorized Official - First Name:SUMITRAJIT
Authorized Official - Middle Name:
Authorized Official - Last Name:DHAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:847-491-2470
Mailing Address - Street 1:2315 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60208-3550
Mailing Address - Country:US
Mailing Address - Phone:847-491-3165
Mailing Address - Fax:847-467-0410
Practice Address - Street 1:2315 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60208-3550
Practice Address - Country:US
Practice Address - Phone:847-491-3165
Practice Address - Fax:847-467-7141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities