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Organization
UNIVERSITY OF ILLINOIS SPEECH AND HEARING
Active
Organization
UNIVERSITY OF ILLINOIS SPEECH AND HEARING
Active
Parent organization
UNIVERSITY OF ILLINOIS
Other names
Speech-Language Pathology Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
UNIVERSITY OF ILLINOIS
Authorized official
CLARION MENDES SLP (DIRECTOR OF CLINICAL EDUCATION)
(217) 333-2205
Entity
Organization
Contact information
Practice address
2001 S OAK ST, SUITE B, CHAMPAIGN, IL 61820-0906
(217) 333-2205
(217) 333-2206
Mailing address
2001 S OAK ST, SUITE B, CHAMPAIGN, IL 61820-0906
(217) 333-2205
(217) 333-2206
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
146000794
IL
235Z00000X
Speech-Language Pathologist
Primary
146003459
IL
235Z00000X
Speech-Language Pathologist
146004209
IL
235Z00000X
Speech-Language Pathologist
146005525
IL
235Z00000X
Speech-Language Pathologist
146008043
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
328742120001
—
IL
05
—
344384568001
—
IL
05
—
356589993001
—
IL
05
—
386640092001
—
IL
05
—
399620438001
—
IL
Enumeration date
02/20/2008
Last updated
08/27/2019
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