Provider Demographics
NPI:1801141882
Name:WASILK, BARBARA M (MA, CCC/SLP-L)
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:M
Last Name:WASILK
Suffix:
Gender:F
Credentials:MA, CCC/SLP-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CIMARRON CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-3341
Mailing Address - Country:US
Mailing Address - Phone:847-516-4615
Mailing Address - Fax:
Practice Address - Street 1:500 CONVENTRY LANE
Practice Address - Street 2:SUITE 170
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014
Practice Address - Country:US
Practice Address - Phone:815-356-2700
Practice Address - Fax:815-356-2709
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-000877235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist