Healthcare Provider Details

I. General information

NPI: 1033661905
Provider Name (Legal Business Name): ALL BRIGHT SPEECH THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1957 W DICKENS AVE
CHICAGO IL
60614-3934
US

IV. Provider business mailing address

1957 W DICKENS AVE
CHICAGO IL
60614-3934
US

V. Phone/Fax

Practice location:
  • Phone: 312-848-6315
  • Fax: 877-227-0804
Mailing address:
  • Phone: 312-848-6315
  • Fax: 877-227-0804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146008671
License Number StateIL

VIII. Authorized Official

Name: MRS. AMANDA ALBRIGHT
Title or Position: OWNER
Credential:
Phone: 312-848-6315