Healthcare Provider Details

I. General information

NPI: 1417757675
Provider Name (Legal Business Name): LITTLE MINDS PEDIATRIC THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

941 REDCLIFF RD
NEW LENOX IL
60451-3556
US

IV. Provider business mailing address

941 REDCLIFF RD
NEW LENOX IL
60451-3556
US

V. Phone/Fax

Practice location:
  • Phone: 708-670-8604
  • Fax:
Mailing address:
  • Phone: 708-670-8604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: STEVE PAC
Title or Position: BUSINESS OWNE
Credential:
Phone: 708-670-8604