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Organization

BLAZING PRAIRIE STARS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. CATHERINE B RAACK M.A.CCC-SLP (CEO)
(630) 365-5550
Entity
Organization

Contact information

Practice address
47W635 BEITH RD, MAPLE PARK, IL 60151-8802
(630) 365-5550
(630) 365-9550
Mailing address
47W635 BEITH ROAD, MAPLE PARK, IL 60151-8802
(630) 365-5550
(630) 365-9550

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
04532110
BLUE CROSS BLUE SHEILD
IL
Enumeration date
01/17/2007
Last updated
08/22/2020
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