Healthcare Provider Details

I. General information

NPI: 1699013219
Provider Name (Legal Business Name): GRADY COONEY SPEECH PARTNERS, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2013
Last Update Date: 10/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4560 W 103RD ST UNIT 2
OAK LAWN IL
60453-4869
US

IV. Provider business mailing address

4560 W 103RD ST UNIT 2
OAK LAWN IL
60453-4869
US

V. Phone/Fax

Practice location:
  • Phone: 773-841-8180
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number68557372
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MAUREEN GRADY COONEY
Title or Position: PRESIDENT/OWNER
Credential: MS, CCC-SLP, COM
Phone: 773-841-8180