Healthcare Provider Details

I. General information

NPI: 1255514543
Provider Name (Legal Business Name): CHATTERBOX SPEECH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3418 MANASSAS DR
EDWARDSVILLE IL
62025-3209
US

IV. Provider business mailing address

3418 MANASSAS DR
EDWARDSVILLE IL
62025-3209
US

V. Phone/Fax

Practice location:
  • Phone: 618-520-2498
  • Fax: 618-692-9633
Mailing address:
  • Phone: 618-520-2498
  • Fax: 618-692-9633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KAREN ANDERSON
Title or Position: SPEECH THERAPIST
Credential: M.S. CCC/SLP-L
Phone: 618-520-2498