Healthcare Provider Details

I. General information

NPI: 1689070732
Provider Name (Legal Business Name): LET IT GROW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2014
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1642 E BARBERRY LN
MOUNT PROSPECT IL
60056-1512
US

IV. Provider business mailing address

1642 E BARBERRY LN
MOUNT PROSPECT IL
60056-1512
US

V. Phone/Fax

Practice location:
  • Phone: 312-650-5522
  • Fax: 312-878-7112
Mailing address:
  • Phone: 312-650-5522
  • Fax: 312-878-7112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: KATHLEEN MAK
Title or Position: MEMBER
Credential:
Phone: 312-650-5522