Healthcare Provider Details

I. General information

NPI: 1285207068
Provider Name (Legal Business Name): WONDERBUS SPEECH THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25136 PATRIOT CT
PLAINFIELD IL
60544-2594
US

IV. Provider business mailing address

25136 PATRIOT CT
PLAINFIELD IL
60544-2594
US

V. Phone/Fax

Practice location:
  • Phone: 847-508-5861
  • Fax:
Mailing address:
  • Phone: 847-508-5861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. GAYLENE MARIE OESTERREICH
Title or Position: SPEECH AND LANGUAGE PATHOLOGIST
Credential: CCC/SLP
Phone: 847-508-5861