Healthcare Provider Details

I. General information

NPI: 1972553709
Provider Name (Legal Business Name): SPECIAL CHILDREN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 WABASH AVE
BELLEVILLE IL
62220-3370
US

IV. Provider business mailing address

1306 WABASH AVE
BELLEVILLE IL
62220-3370
US

V. Phone/Fax

Practice location:
  • Phone: 618-234-6876
  • Fax: 618-234-6150
Mailing address:
  • Phone: 618-234-6876
  • Fax: 618-234-6150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateIL

VIII. Authorized Official

Name: JOHN HILL
Title or Position: CONTROLLER
Credential:
Phone: 618-234-6876