Provider Demographics
NPI:1730721937
Name:POLIRER, AMANDA JENNIFER (MS CF-SLP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JENNIFER
Last Name:POLIRER
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:MANDI
Other - Middle Name:JENNIFER
Other - Last Name:POLIRER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS CF-SLP
Mailing Address - Street 1:1140 NORTH LASALLE DRIVE
Mailing Address - Street 2:APARTMENT 413
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610
Mailing Address - Country:US
Mailing Address - Phone:847-323-8159
Mailing Address - Fax:
Practice Address - Street 1:4100 JOLIET AVE
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:IL
Practice Address - Zip Code:60534-1513
Practice Address - Country:US
Practice Address - Phone:708-783-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist