Healthcare Provider Details

I. General information

NPI: 1568635266
Provider Name (Legal Business Name): TINY TOTS PEDIATRIC THERAPIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 VINE AVE
PARK RIDGE IL
60068-5324
US

IV. Provider business mailing address

1900 S VINE AVE
PARK RIDGE IL
60068-5324
US

V. Phone/Fax

Practice location:
  • Phone: 847-281-6993
  • Fax:
Mailing address:
  • Phone: 847-281-6993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146004653
License Number StateIL

VIII. Authorized Official

Name: KELLY CREES
Title or Position: SPEECH PATHOLOGY
Credential: MA CCC SLP
Phone: 847-281-6993