Provider Demographics
NPI:1649481136
Name:PARDUCCI, ANCILLA LOUISE
Entity type:Individual
Prefix:MS
First Name:ANCILLA
Middle Name:LOUISE
Last Name:PARDUCCI
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 1:1930 41ST ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-4501
Mailing Address - Country:US
Mailing Address - Phone:309-558-9223
Mailing Address - Fax:309-797-5526
Practice Address - Street 1:1930 41ST ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-4501
Practice Address - Country:US
Practice Address - Phone:309-558-9223
Practice Address - Fax:309-797-5526
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILAP99990804P222Q00000X
IL146.015119235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist