Provider Demographics
NPI:1649730458
Name:RUBEL, ELIZABETH FAY
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:FAY
Last Name:RUBEL
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 1:30 WOODLAKE BLVD APT 2604
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-6713
Mailing Address - Country:US
Mailing Address - Phone:847-507-0103
Mailing Address - Fax:
Practice Address - Street 1:1201 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-2081
Practice Address - Country:US
Practice Address - Phone:224-303-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist