Healthcare Provider Details

I. General information

NPI: 1437558954
Provider Name (Legal Business Name): LEVEL UP PEDIATRIC SPEECH THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2014
Last Update Date: 03/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 WAGNER RD
NORTHFIELD IL
60093-3248
US

IV. Provider business mailing address

289 WAGNER RD
NORTHFIELD IL
60093-3248
US

V. Phone/Fax

Practice location:
  • Phone: 773-350-9229
  • Fax: 773-595-4608
Mailing address:
  • Phone: 773-350-9229
  • Fax: 773-595-4608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146.011212
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number146.011212
License Number StateIL

VIII. Authorized Official

Name: KATHERINE T DIVALERIO
Title or Position: SPEECH LANGUAGE PATHOLOGIST/OWNER
Credential: M.A.,CCC-SLP
Phone: 773-350-9229