Healthcare Provider Details

I. General information

NPI: 1124163332
Provider Name (Legal Business Name): ASPIRE OF ILLINOIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 S WOLF RD
HILLSIDE IL
60162
US

IV. Provider business mailing address

1815 S WOLF RD
HILLSIDE IL
60162-2110
US

V. Phone/Fax

Practice location:
  • Phone: 708-236-0979
  • Fax: 708-236-5161
Mailing address:
  • Phone: 708-236-0979
  • Fax: 708-236-5161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: ANN-PRESTON BOSHER
Title or Position: ASSOC. DIR. OF PEDIATRIC THERAPIES
Credential: PT, DPT
Phone: 708-236-0979