The Board of Trustees of the University of Illinois
Organization Active NPI Early Intervention Provider Agency · Chicago, IL
NPI 1174554331 · NPPES record last updated Jun 17, 2026
Key facts
- NPI
- 1174554331
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Early Intervention Provider Agency 252Y00000X
- Legal business name
- THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
- Practice address
- 1640 W Roosevelt Rd
Chicago, IL 60608-1336 - Phone
- (312) 996-6695
- Fax
- (312) 413-0086
- NPI assigned
- Jul 6, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Authorized official
- Name
- Mary Therese Keehn, PT
- Title
- Assoc Dean for Clinical Affairs
- Phone
- (312) 413-2873
Other NPIs on the same Medicare enrollment 44
Corporate family (same tax ID) 24
Practitioners 20
-
Sarah Anderson, OTR/L
-
Wing Yee Joyce Chau, MS, CCC-SLP
-
Kelly Ann Giuliano, OTR/L
-
Debbie Dora Harper, M.A. CCC-SLP
-
Brandi Hosford, PT,DPT
-
Reid Kelso Kiger, DPT
-
Aubrey Little, PT, DPT
-
Gillian Ashley McLean, PT, DPT
-
Nathan O'Connor, DPT
-
Oliver Rivera, PT, DPT
-
Richard E Sroka, PT
-
Kelly Ann Vaez, FNP
-
Aaron Paul Keil, P.T.
-
McKenzie Mary Mok, MA, CCC-SLP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031112000158 | IL | Part B Supplier - Clinic/Group Practice | 3072422716 |
Receives reassigned benefits from 2,115 practitioners 44 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Univ of Illinois Hospit
- Part of
- Univ of Illinois Hospit
Locations
5254 Solution Ctr
Chicago, IL 60677
1640 W Roosevelt Rd
#727
Chicago, IL 60608
Phone (312) 413-1871
808 S Wood St
Ste 169
Chicago, IL 60612
1640 W Roosevelt Rd
Rm 336
Chicago, IL 60608
Phone (312) 413-1563
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor |
101YP2500X | |||
| Behavior Analyst |
103K00000X | |||
| Clinical Psychologist |
103TC0700X | |||
| Clinical Social Worker |
1041C0700X | |||
| Developmental Therapist |
222Q00000X | |||
| Physical Therapist |
225100000X | |||
| Occupational Therapist |
225X00000X | |||
| Speech-Language Pathologist |
235Z00000X | |||
| Early Intervention Provider Agency | 252Y00000X | Yes | ||
| Occupational Medicine Clinic/Center | 261QX0100X |
Addresses
Primary practice location
1640 W Roosevelt Rd
Chicago, IL 60608-1336
Mailing address
808 S Wood St Ste 169
Chicago, IL 60612-7306
Phone (312) 996-6695
Other names
- College of Applied Health Sciences Faculty Practice
Other providers in Chicago, IL
- The Board of Trustees of the University of Illinois
- The Board of Trustees of the University of Illinois
- The Board of Trustees of the University of Illinois
- The Board of Trustees of the University of Illinois
- The Board of Trustees of the University of Illinois
- The Board of Trustees of the University of Illinois
- The Board of Trustees of the University of Illinois
- The Board of Trustees of the University of Illinois
- The Board of Trustees of the University of Illinois
- The Board of Trustees of the University of Illinois
All providers in Chicago, IL · Early Intervention Provider Agency in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 17, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.