Provider Demographics
NPI:1861110413
Name:NARDULLI, ANNALISA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANNALISA
Middle Name:
Last Name:NARDULLI
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 N DENAL ST
Mailing Address - Street 2:
Mailing Address - City:NORRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60706-2802
Mailing Address - Country:US
Mailing Address - Phone:708-407-4338
Mailing Address - Fax:
Practice Address - Street 1:7616 E PRAIRIE RD
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-3758
Practice Address - Country:US
Practice Address - Phone:847-673-1141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14306381235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14306381Medicaid