Provider Demographics
NPI:1437168150
Name:BILLINGSLY, DANICA M S (AUD)
Entity type:Individual
Prefix:DR
First Name:DANICA
Middle Name:M S
Last Name:BILLINGSLY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:DANICA
Other - Middle Name:MARIE
Other - Last Name:SIEFKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3100 SYCAMORE RD
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-9621
Mailing Address - Country:US
Mailing Address - Phone:815-753-1481
Mailing Address - Fax:815-753-1664
Practice Address - Street 1:3100 SYCAMORE RD
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-9621
Practice Address - Country:US
Practice Address - Phone:815-753-1481
Practice Address - Fax:815-753-1664
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI420-156231H00000X
IL147.001225231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41145800Medicaid
WI41145800Medicaid
52110-0182Medicare ID - Type UnspecifiedMEDICARE PROVIDER
IL$$$$$$$$$001Medicaid