Healthcare Provider Details

I. General information

NPI: 1295113918
Provider Name (Legal Business Name): BEYOND WORDS BEHAVIOR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 05/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 N PARK BLVD
GLEN ELLYN IL
60137-5713
US

IV. Provider business mailing address

706 HIGHLAND AVE
GLEN ELLYN IL
60137-3822
US

V. Phone/Fax

Practice location:
  • Phone: 630-297-3540
  • Fax:
Mailing address:
  • Phone: 630-297-3540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146008858
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-15-17909
License Number StateIL

VIII. Authorized Official

Name: JILL ALLISON CARTER-MARSHALL
Title or Position: SPEECH PATHOLOGIST, BCBA
Credential: CCC-SLP, BCBA
Phone: 630-297-3540