Healthcare Provider Details

I. General information

NPI: 1336426709
Provider Name (Legal Business Name): COMMUNICATE CHICAGO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2011
Last Update Date: 11/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W MADISON ST #512
CHICAGO IL
60607-1936
US

IV. Provider business mailing address

1301 W MADISON ST #512
CHICAGO IL
60607-1936
US

V. Phone/Fax

Practice location:
  • Phone: 312-806-0769
  • Fax: 312-577-1706
Mailing address:
  • Phone: 312-806-0769
  • Fax: 312-577-1706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146008947
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number146008947
License Number StateIL

VIII. Authorized Official

Name: MICHAEL JOHN NEARY JR.
Title or Position: OWNER
Credential: M.S., CCC-SLP
Phone: 312-806-0769