Healthcare Provider Details

I. General information

NPI: 1770324493
Provider Name (Legal Business Name): ASHLEY LARISEY SPEECH SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2024
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12400 S HARLEM AVE STE 2NE
PALOS HEIGHTS IL
60463-1440
US

IV. Provider business mailing address

10040 S FAIRFIELD AVE
CHICAGO IL
60655-1640
US

V. Phone/Fax

Practice location:
  • Phone: 312-298-9003
  • Fax: 877-920-1765
Mailing address:
  • Phone: 316-519-0531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY LARISEY
Title or Position: OWNER
Credential: M.S., CCC-SLP/L
Phone: 316-519-0531