Basic Information
| Provider Information | |||||||||
| NPI: | 1487701660 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MORETTINI | ||||||||
| FirstName: | DEBRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1860 W WINCHESTER RD | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | LIBERTYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600485351 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 1860 W WINCHESTER RD | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | LIBERTYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600485351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475739486 | ||||||||
| FaxNumber: | 8475496139 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | IL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.