Provider Demographics
NPI:1881916195
Name:BIRKY, NANETTE MARIE
Entity type:Individual
Prefix:
First Name:NANETTE
Middle Name:MARIE
Last Name:BIRKY
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 1:515 W EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:IL
Mailing Address - Zip Code:61732-9266
Mailing Address - Country:US
Mailing Address - Phone:309-963-4493
Mailing Address - Fax:
Practice Address - Street 1:515 W EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:IL
Practice Address - Zip Code:61732-9266
Practice Address - Country:US
Practice Address - Phone:309-963-4493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-28
Last Update Date:2010-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.000622235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist