Provider Demographics
NPI:1336415447
Name:SWIDERSKI, ELLEN J (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:J
Last Name:SWIDERSKI
Suffix:
Gender:F
Credentials:MS CCC-SLP
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:801 S MILWAUKEE AVE
Mailing Address - Street 2:REHAB DEPT, WEST TOWER
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3204
Mailing Address - Country:US
Mailing Address - Phone:847-990-5350
Mailing Address - Fax:847-549-6920
Practice Address - Street 1:801 S MILWAUKEE AVE
Practice Address - Street 2:REHAB DEPT, WEST TOWER
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3204
Practice Address - Country:US
Practice Address - Phone:847-990-5350
Practice Address - Fax:847-549-6920
Is Sole Proprietor?:No
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.010794235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist