NPIMap

Organization Active NPI

Pediatric Fundamentals,LLC

  • Speech-Language Pathologist
  • Custer Park, IL
National Provider Identifier
1396155156
Registry record updated May 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
146006731 Issued in IL
Legal business name
PEDIATRIC FUNDAMENTALS,LLC
Practice address
36963 Irish LN
Custer Park, IL 60481-8420
Phone
(815) 931-8595
NPI assigned
May 2, 2014
Last updated
May 2, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 2, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Shauna J Ruzich, MS CCC-SLP
Title
Owner/Manager
Phone
(815) 931-8595

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 146006731 IL Primary

Addresses

Primary practice location

36963 Irish LN
Custer Park, IL 60481-8420

Mailing address

36963 Irish LN
Custer Park, IL 60481-8420

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1398988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398988800000",
    "number": "1396155156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36963 IRISH LN",
            "city": "CUSTER PARK",
            "state": "IL",
            "postal_code": "604818420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36963 IRISH LN",
            "city": "CUSTER PARK",
            "state": "IL",
            "postal_code": "604818420",
            "telephone_number": "815-931-8595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC FUNDAMENTALS,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-02",
        "last_updated": "2014-05-02",
        "status": "A",
        "authorized_official_last_name": "RUZICH",
        "authorized_official_first_name": "SHAUNA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "815-931-8595",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MS CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146006731",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Custer Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.