Healthcare Provider Details

I. General information

NPI: 1982201356
Provider Name (Legal Business Name): SONGBIRD HEALTH IL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2020
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 W GRAND AVE
CHICAGO IL
60612-1576
US

IV. Provider business mailing address

2045 W GRAND AVE STE B #17739
CHICAGO IL
60612
US

V. Phone/Fax

Practice location:
  • Phone: 312-448-7310
  • Fax: 209-336-0490
Mailing address:
  • Phone: 312-448-7310
  • Fax: 209-336-0490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN HSU
Title or Position: CO-FOUNDER
Credential:
Phone: 571-244-4592