Healthcare Provider Details

I. General information

NPI: 1427284884
Provider Name (Legal Business Name): ADVANCEMENT TX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2009
Last Update Date: 05/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 TOWN CENTER RD SUITE 201
MATTESON IL
60443-2251
US

IV. Provider business mailing address

4710 LINCOLN HWY SUITE 263
MATTESON IL
60443-2316
US

V. Phone/Fax

Practice location:
  • Phone: 708-748-5700
  • Fax: 800-430-8150
Mailing address:
  • Phone: 800-430-8150
  • Fax: 800-430-8150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146.008715
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number146.008715
License Number StateIL

VIII. Authorized Official

Name: SHAWNISE TAYLOR
Title or Position: SPEECH PATHOLOGIST/OWNER
Credential: M.S.CCC-SLP/L
Phone: 800-430-8150