Healthcare Provider Details

I. General information

NPI: 1659740306
Provider Name (Legal Business Name): EMPOWERING LIGHT LANGUAGE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2015
Last Update Date: 09/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 W GREENLEAF AVE #1
CHICAGO IL
60626-2303
US

IV. Provider business mailing address

1851 W GREENLEAF AVE #1
CHICAGO IL
60626-2303
US

V. Phone/Fax

Practice location:
  • Phone: 847-567-4978
  • Fax:
Mailing address:
  • Phone: 847-567-4978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number146009236
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number146009236
License Number StateIL

VIII. Authorized Official

Name: SIRIS RIVAS
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: M.A.
Phone: 847-567-4978