Susan Mary Bickline – Speech-Language Pathologist

Key facts

NPI: 1659635688
Entity type: Individual (NPI type 1)
Primary specialty: Speech-Language Pathologist 235Z00000X
License: 146003579 (IL)
Practice address: 9515 Holy Cross LN
Box 99
Breese, IL 62230-3618
Phone: (618) 526-4511
Fax: (618) 526-2855
NPI assigned: Jun 25, 2012
Sex: Female
Sole proprietor: Yes

Organizations & group practices 1

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.

St Josephs Hospital Breese of the Hospital Sisters of the Third Orde General Acute Care Hospital · Breese, IL · NPI 1457319154

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
146003579	IL	MD	Speech-Language Pathologist

Practice roles

Organization	Specialty	Status	New patients
St Josephs Hospital Breese of the Hospital Sisters of the Third Orde		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Speech-Language Pathologist	235Z00000X	146003579	IL	Yes

Addresses

Primary practice location

9515 Holy Cross LN
Box 99
Breese, IL 62230-3618

Mailing address

9515 Holy Cross LN
Box 99
Breese, IL 62230-3618
Phone (618) 526-4511

Other providers in Breese, IL

All providers in Breese, 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 Jun 25, 2012. 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.

Verify at the official NPI Registry.