Healthcare Provider Details

I. General information

NPI: 1285293886
Provider Name (Legal Business Name): CORAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2019
Last Update Date: 08/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1571 W GROVE ST
ADDISON IL
60101-5769
US

IV. Provider business mailing address

1571 W GROVE ST
ADDISON IL
60101-5769
US

V. Phone/Fax

Practice location:
  • Phone: 847-529-4339
  • Fax: 630-625-6015
Mailing address:
  • Phone: 847-529-4339
  • Fax: 630-625-6015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. ANJELICA SIERRA
Title or Position: PRESIDENT
Credential: MHS., CCC-SLP
Phone: 847-529-4339