MEDICARE: THRIVE KIDS SPEECH THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355S0801X	Speech-Language Assistant
2	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1215888193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIVE KIDS SPEECH THERAPY LLC

Provider Business Mailing Address
First Line	:	10733 REVERE RD
Second Line	:
City	:	MOKENA
State	:	IL
Zip	:	60448-1903
Country	:	US
Telephone Number	:	708-837-8869
Fax Number	:	708-694-7006

Provider Business Practice Location Address
First Line	:	10733 REVERE RD
Second Line	:
City	:	MOKENA
State	:	IL
Zip	:	60448-1903
Country	:	US
Telephone Number	:	708-837-8869
Fax Number	:	708-694-7006

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST
Name	:	TAYLOR KIMBROUGH
Credential	:	MS, CCC-SLP/L
Telephone Number	:	708-837-8869

Provider Enumeration Date	:	02/05/2026
Last Update Date	:	02/05/2026

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Directions to “THRIVE KIDS SPEECH THERAPY LLC ” Practice Location

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