Provider Demographics
NPI:1740014612
Name:VANCE, ELEANOR SUZANNE
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:SUZANNE
Last Name:VANCE
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 1:6727 N EDGEBROOK TER
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-2702
Mailing Address - Country:US
Mailing Address - Phone:773-318-6483
Mailing Address - Fax:
Practice Address - Street 1:66 W OAK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-2800
Practice Address - Country:US
Practice Address - Phone:312-705-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-31
Last Update Date:2024-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist