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Organization
WOODSTOCK STUTTERING SPECIALIST
Active
Organization
WOODSTOCK STUTTERING SPECIALIST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN ELDRIDGE PHD (SLP/SOLE PROPRIETOR)
(815) 403-1135
Entity
Organization
Contact information
Practice address
110 WASHINGTON ST, WOODSTOCK, IL 60098-3305
(815) 308-5477
(815) 334-1136
Mailing address
110 WASHINGTON ST, WOODSTOCK, IL 60098-3305
(815) 308-5477
(815) 334-1136
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146.006432
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1568616944
INDIVIDUAL NPI
—
Enumeration date
04/28/2014
Last updated
04/28/2014
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