Healthcare Provider Details

I. General information

NPI: 1821935149
Provider Name (Legal Business Name): NATURAL ROOTS SPEECH THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 S LA GRANGE RD STE 205
LA GRANGE IL
60525-6348
US

IV. Provider business mailing address

3241 FOX ST APT 1A
WOODRIDGE IL
60517-3204
US

V. Phone/Fax

Practice location:
  • Phone: 708-232-3120
  • Fax:
Mailing address:
  • Phone: 630-890-5615
  • 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: MAISON TOLLAS
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential:
Phone: 630-890-5615