Diane Meck Eisenberg

Individual provider Active NPI Speech-Language Pathologist · Villa Park, IL

NPI 1164527982 · NPPES record last updated Jul 9, 2007

Key facts

NPI
1164527982
Entity type
Individual (NPI type 1)
Primary specialty
Speech-Language Pathologist 235Z00000X
Practice address
830 S Addison Ave
Villa Park, IL 60181-2877
Phone
(630) 620-4433
Fax
(630) 620-1148
NPI assigned
Sep 14, 2006
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
146-003013ILMDSpeech-Language Pathologist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X IL Yes

Addresses

Primary practice location

830 S Addison Ave
Villa Park, IL 60181-2877

Mailing address

830 S Addison Ave
Villa Park, IL 60181-2877
Phone (630) 620-4433

Other identifiers

IdentifierTypeStateIssuer
652606847001MedicaidIL

Other names

  • Diane Meck Former name

Other providers in Villa Park, IL

All providers in Villa Park, IL · Speech-Language Pathologist in Illinois

Sources for this page

Verify at the official NPI Registry.