MEDICARE: SOCIALLY SPEAKING 4 KIDS, INC.

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	251C00000X	Developmentally Disabled Services Day Training Agency
2	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1467786749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOCIALLY SPEAKING 4 KIDS, INC.

Provider Business Mailing Address
First Line	:	1507 E 53RD ST
Second Line	:	UNIT 703
City	:	CHICAGO
State	:	IL
Zip	:	60615-4573
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1507 E 53RD ST
Second Line	:	UNIT 703
City	:	CHICAGO
State	:	IL
Zip	:	60615-4573
Country	:	US
Telephone Number	:	312-485-1589
Fax Number	:

Authorized Official
Title or Position	:	PRINCIPAL
Name	:	NICOLE ALLEN
Credential	:
Telephone Number	:	312-485-1589

Provider Enumeration Date	:	09/20/2009
Last Update Date	:	09/20/2009

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