Connie R Izquierdo, M.A. CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

146005764 Issued in IL

Practice address

1131 Central Ave Ste 9
Wilmette, IL 60091-2644

Phone

(847) 251-6190

Fax

(847) 251-6085

NPI assigned

Mar 7, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Interactive Speech Associates

  • Speech-Language Pathologist
  • Skokie, IL
  • NPI 1609975507
  NPD (past) Authorized official
• Interactive Speech Associates, Inc

  • Speech-Language Pathologist
  • Wilmette, IL
  • NPI 1558716456
  NPD (past) Authorized official

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1598895575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1131 CENTRAL AVE STE 9",
            "city": "WILMETTE",
            "state": "IL",
            "postal_code": "600912644",
            "telephone_number": "847-251-6190",
            "fax_number": "847-251-6085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1131 CENTRAL AVE STE 9",
            "city": "WILMETTE",
            "state": "IL",
            "postal_code": "600912644",
            "telephone_number": "847-251-6190",
            "fax_number": "847-251-6085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IZQUIERDO",
        "first_name": "CONNIE",
        "middle_name": "R",
        "credential": "M.A. CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-07",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146005764",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Images Med Spa Old Orchard LLC
• Inner Elements LLC
• Ravadee Inphom, P.T.
• Integrated Holistic Healthcare, S.C.
• Interactive Speech Associates, Inc
• Elise Jacob
• Matthew Jacoby
• Jacqueline Duke, PSYD, LLC
• Ashor Jajou, MSW
• Gerta S Janss, MD

• Speech-Language Pathologist in Wilmette, IL
• Providers in Wilmette, IL by specialty
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.