Healthcare Provider Details

I. General information

NPI: 1174652614
Provider Name (Legal Business Name): OAK TREE DEVELOPMENTAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 N WELLS ST UNIT 103
CHICAGO IL
60614-6006
US

IV. Provider business mailing address

1640 N WELLS ST UNIT 103
CHICAGO IL
60614-6006
US

V. Phone/Fax

Practice location:
  • Phone: 312-642-4300
  • Fax: 312-642-4302
Mailing address:
  • Phone: 312-642-4300
  • Fax: 312-642-4302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateIL

VIII. Authorized Official

Name: MS. MARY A CRUM
Title or Position: SPEECH PATHOLOGIST
Credential: MA CCC SLPL
Phone: 312-642-4300