Provider Demographics
NPI:1730329426
Name:WESTERN ILLINOIS UNIVERSITY SPEECH LANGUAGE HEARING CLINIC
Entity type:Organization
Organization Name:WESTERN ILLINOIS UNIVERSITY SPEECH LANGUAGE HEARING CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGY CLINIC COORDINATOR
Authorized Official - Prefix:PROF
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:SILBERER
Authorized Official - Suffix:
Authorized Official - Credentials:AUD, CCC/A
Authorized Official - Phone:309-298-1955
Mailing Address - Street 1:1 UNIVERSITY CIR
Mailing Address - Street 2:125 CURRENS HALL
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455-1367
Mailing Address - Country:US
Mailing Address - Phone:309-298-1955
Mailing Address - Fax:309-298-2049
Practice Address - Street 1:1 UNIVERSITY CIR
Practice Address - Street 2:125 CURRENS HALL
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-1367
Practice Address - Country:US
Practice Address - Phone:309-298-1955
Practice Address - Fax:309-298-2049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147001084237600000X
IL14700928237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty