NPIMap

Organization Active NPI

Northern Illinois University

Doing business as Speech Language Hearing Clinic

  • Audiologist
  • Dekalb, IL
National Provider Identifier
1407916836
Registry record updated Jul 10, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
Legal business name
NORTHERN ILLINOIS UNIVERSITY
Doing business as
Speech Language Hearing Clinic
Practice address
3100 Sycamore Rd
Niu Speech Language Hearing Clinic
Dekalb, IL 60115-9621
Phone
(815) 753-1481
Fax
(815) 753-1664
NPI assigned
Dec 8, 2006
Last updated
Jul 10, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
NORTHERN ILLINOIS UNIVERSITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 10, 2013

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

Authorized official

Name
Carissa Nicole Callahan
Title
Assistant to the Dean
Phone
(815) 753-6161

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X NU Primary
Speech-Language Pathologist 235Z00000X NU

Addresses

Primary practice location

3100 Sycamore Rd
Niu Speech Language Hearing Clinic
Dekalb, IL 60115-9621

Mailing address

3100 Sycamore Rd
Niu Speech Language Hearing Clinic
Dekalb, IL 60115-9621
Phone (815) 753-1481

Other names 1

  • Speech Language Hearing Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050104000460 IL Part B Supplier - Clinic/Group Practice 2860440195 Receives reassigned benefits from 17 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Dekalb, IL

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Psychological Services6 organizations share this tax ID, including this one
Part of
Psychological Services

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373414400000",
    "number": "1407916836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 SYCAMORE RD",
            "address_2": "NIU SPEECH LANGUAGE HEARING CLINIC",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601159621",
            "telephone_number": "815-753-1481",
            "fax_number": "815-753-1664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 SYCAMORE RD",
            "address_2": "NIU SPEECH LANGUAGE HEARING CLINIC",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601159621",
            "telephone_number": "815-753-1481",
            "fax_number": "815-753-1664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN ILLINOIS UNIVERSITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHERN ILLINOIS UNIVERSITY",
        "enumeration_date": "2006-12-08",
        "last_updated": "2013-07-10",
        "status": "A",
        "authorized_official_last_name": "CALLAHAN",
        "authorized_official_first_name": "CARISSA",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "ASSISTANT TO THE DEAN",
        "authorized_official_telephone_number": "815-753-6161"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Speech Language Hearing Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dekalb, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.