Provider Demographics
NPI:1134227879
Name:NORDBY, ELIZABETH ANN (MA CCCSLPL)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN
Last Name:NORDBY
Suffix:
Gender:F
Credentials:MA CCCSLPL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 N MARSHFIELD AVE
Mailing Address - Street 2:# 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-3820
Mailing Address - Country:US
Mailing Address - Phone:773-486-0176
Mailing Address - Fax:773-486-0176
Practice Address - Street 1:1016 N MARSHFIELD AVE
Practice Address - Street 2:# 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-3820
Practice Address - Country:US
Practice Address - Phone:773-220-6812
Practice Address - Fax:773-486-0176
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
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
IL1635115OtherBLUE CROSS BLUE SHIELD