Healthcare Provider Details

I. General information

NPI: 1912072729
Provider Name (Legal Business Name): ILLINOIS WISCONSIN SERTOMA REGIONAL CENTER FOR COMMUNICATIVE DISORDERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10409 SOUTH ROBERTS ROAD
PALOS HILLS IL
60465
US

IV. Provider business mailing address

10409 SOUTH ROBERTS ROAD
PALOS HILLS IL
60465
US

V. Phone/Fax

Practice location:
  • Phone: 708-599-9500
  • Fax: 708-599-2791
Mailing address:
  • Phone: 708-599-9500
  • Fax: 708-599-2791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146002791
License Number StateIL

VIII. Authorized Official

Name: DR. MICHELLE KALEEN MORRISON
Title or Position: EXECUTIVE DIRECTOR
Credential: ED.D. CCC-SLP
Phone: 708-599-9500