NPIMap

Organization Active NPI

Sovereign Pediatric

  • Early Intervention Provider Agency
  • Lisle, IL
National Provider Identifier
1669922217
Registry record updated Oct 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Early Intervention Provider AgencyTaxonomy code 252Y00000X
License
146.010876 Issued in IL
Legal business name
SOVEREIGN PEDIATRIC
Practice address
1990 Green Trails Dr
Lisle, IL 60532-3345
Phone
(630) 370-2711
NPI assigned
Oct 6, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2016

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

Authorized official

Name
Susan Binder, MA, SLPNPI 1417443193
Title
Speech Pathologist
Phone
(630) 370-2711

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Early Intervention Provider Agency 252Y00000X 146.010876 IL Primary

Addresses

Primary practice location

1990 Green Trails Dr
Lisle, IL 60532-3345

Mailing address

1990 Green Trails Dr
Lisle, IL 60532-3345
Phone (630) 370-2711

National Provider Directory

National Provider Directory
Tax ID family
Sovereign Pediatric2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1475712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475712000000",
    "number": "1669922217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1990 GREEN TRAILS DR",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605323345",
            "telephone_number": "630-370-2711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1990 GREEN TRAILS DR",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605323345",
            "telephone_number": "630-370-2711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOVEREIGN PEDIATRIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-06",
        "last_updated": "2016-10-06",
        "status": "A",
        "authorized_official_last_name": "BINDER",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "SPEECH PATHOLOGIST",
        "authorized_official_telephone_number": "630-370-2711",
        "authorized_official_credential": "MA, SLP"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "IL",
            "license": "146.010876",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lisle, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2016; 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.