Healthcare Provider Details

I. General information

NPI: 1811918063
Provider Name (Legal Business Name): AIM THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4956 ROCKY BRANCH RD
BETHALTO IL
62010-2540
US

IV. Provider business mailing address

4956 ROCKY BRANCH RD
BETHALTO IL
62010-2540
US

V. Phone/Fax

Practice location:
  • Phone: 618-401-4201
  • Fax: 618-377-7011
Mailing address:
  • Phone: 618-401-4201
  • Fax: 618-377-7011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateIL

VIII. Authorized Official

Name: ROBIN WZOREK
Title or Position: OWNER
Credential: SLP
Phone: 618-401-4201