Healthcare Provider Details

I. General information

NPI: 1982990503
Provider Name (Legal Business Name): TARLE SPEECH AND LANGUAGE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 06/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W OAKDALE AVE APT 4
CHICAGO IL
60657-5396
US

IV. Provider business mailing address

622 W OAKDALE AVE APT 4
CHICAGO IL
60657-5396
US

V. Phone/Fax

Practice location:
  • Phone: 216-272-7039
  • Fax:
Mailing address:
  • Phone: 216-272-7039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberSP5600
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberIL146.007392
License Number StateIL

VIII. Authorized Official

Name: JENNIFER TARLE-PAKULSKI
Title or Position: OWNER AND LEAD SPEECH THERAPIST
Credential: MA CCC-SLP
Phone: 216-272-7039