1346672524 NPI number — MR. EDWARD ANTHONY STRUGALLA M.H.S., CCC-SLP/L

Table of content: MR. EDWARD ANTHONY STRUGALLA M.H.S., CCC-SLP/L (NPI 1346672524)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346672524 NPI number — MR. EDWARD ANTHONY STRUGALLA M.H.S., CCC-SLP/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STRUGALLA
Provider First Name:
EDWARD
Provider Middle Name:
ANTHONY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.H.S., CCC-SLP/L
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346672524
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
38W930 MCNAIR DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GENEVA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60134-6176
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-404-3652
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 E WILSON ST STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATAVIA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60510-3157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-761-0900
Provider Business Practice Location Address Fax Number:
630-761-0909
Provider Enumeration Date:
07/30/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  146.012303 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 111205100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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