Healthcare Provider Details

I. General information

NPI: 1881603025
Provider Name (Legal Business Name): PEDIATRIC COMMUNICATION SPECIALISTS, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11600 S KEDZIE AVE
MERRIONETTE PARK IL
60803-6302
US

IV. Provider business mailing address

11600 S KEDZIE AVE
MERRIONETTE PARK IL
60803-6302
US

V. Phone/Fax

Practice location:
  • Phone: 708-597-4036
  • Fax: 708-597-4037
Mailing address:
  • Phone: 708-597-4036
  • Fax: 708-597-4037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateIL

VIII. Authorized Official

Name: MS. ELIZABETH LOWERY
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: MHS, CCC
Phone: 708-597-4036