Provider Demographics
NPI:1356798748
Name:BIASCO, CALLIE J
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:J
Last Name:BIASCO
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 1:500 S CAN DOTA AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-3614
Mailing Address - Country:US
Mailing Address - Phone:708-650-8202
Mailing Address - Fax:
Practice Address - Street 1:500 S CAN DOTA AVE
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-3614
Practice Address - Country:US
Practice Address - Phone:708-650-8202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2318122235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist