Healthcare Provider Details

I. General information

NPI: 1619885100
Provider Name (Legal Business Name): A NEW VILLAGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17608 STONEBRIDGE DR
HAZEL CREST IL
60429-2012
US

IV. Provider business mailing address

17608 STONEBRIDGE DR
HAZEL CREST IL
60429-2012
US

V. Phone/Fax

Practice location:
  • Phone: 256-652-5053
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KOURTNEY NEW
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential:
Phone: 256-652-5053