Avery Polizzi
Individual provider Active NPI Speech-Language Pathologist · Broadview, IL
NPI 1245711985 · NPPES record last updated Aug 21, 2018
Key facts
- NPI
- 1245711985
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- Practice address
- 1927 S 15TH Ave
Broadview, IL 60155-3005 - Phone
- (317) 408-8662
- NPI assigned
- Aug 21, 2018
- 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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | |||
| Speech-Language Pathologist | 235Z00000X | IL | Yes |
Addresses
Primary practice location
1927 S 15TH Ave
Broadview, IL 60155-3005
Mailing address
1417 W Waveland Ave
Chicago, IL 60613-3712
Phone (317) 408-8662
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992820757 | Medicaid | IL |
Other providers in Broadview, IL
- Genoveva Perez
- Kenita J. Perry-Bell
- David Phan
- Thomas Alan Plach
- Britteny Poe
- Prakash K. Upadhyaya DDS LTD.
- Presence Behavioral Health
- Presence Behavioral Health
- Sarah Jean Prokop
- Brian Louis Raymond
All providers in Broadview, IL · Speech-Language Pathologist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 21, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.