Active NPI
Theresa Petru
- Speech-Language Pathologist
- Burr Ridge, IL
National Provider Identifier
1114298833
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 146010983
- Practice address
- 16W361 S Frontage Rd
Ste 131
Burr Ridge, IL 60527-5830 - Phone
- (630) 590-5571
- NPI assigned
- Jan 26, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 146010983 | IL | Primary |
Addresses
Primary practice location
16W361 S Frontage Rd
Ste 131
Burr Ridge, IL 60527-5830
Mailing address
16W361 S Frontage Rd
Ste 131
Burr Ridge, IL 60527-5830
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 146010983 | IL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1327536000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1327536000000",
"number": "1114298833",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16W361 S FRONTAGE RD",
"address_2": "STE 131",
"city": "BURR RIDGE",
"state": "IL",
"postal_code": "605275830"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16W361 S FRONTAGE RD",
"address_2": "STE 131",
"city": "BURR RIDGE",
"state": "IL",
"postal_code": "605275830",
"telephone_number": "630-590-5571"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRU",
"first_name": "THERESA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-01-26",
"last_updated": "2012-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "146010983",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Burr Ridge, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.