Healthcare Provider Details

I. General information

NPI: 1114081676
Provider Name (Legal Business Name): S&S SPEECH AND HEARING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2309 PROVIDENCE CT
NAPERVILLE IL
60565-3124
US

IV. Provider business mailing address

PO BOX 616
FOREST PARK IL
60130-0616
US

V. Phone/Fax

Practice location:
  • Phone: 708-366-7177
  • Fax: 708-366-3301
Mailing address:
  • Phone: 708-366-7177
  • Fax: 708-366-3301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateIL

VIII. Authorized Official

Name: DACHEPALLI SRINIVAS
Title or Position: PHYSICIAN
Credential: MD
Phone: 708-366-7177