Basic Information
| Provider Information | |||||||||
| NPI: | 1639617400 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TEITCHER | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | ELAN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7901 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | ELMHURST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113731329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183344000 | ||||||||
| FaxNumber: | 7183343909 | ||||||||
| Practice Location | |||||||||
| Address1: | 1611 W HARRISON ST STE 530 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606124861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129426240 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2017 | ||||||||
| LastUpdateDate: | 07/09/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 024546 | NY | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 146.014608 | IL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.