Healthcare Provider Details

I. General information

NPI: 1962368985
Provider Name (Legal Business Name): IMMERSION SPEECH THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2026
Last Update Date: 01/03/2026
Certification Date: 01/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14200 S ROUTE 30 UNIT 100
PLAINFIELD IL
60544-1067
US

IV. Provider business mailing address

14200 S ROUTE 30 UNIT 100
PLAINFIELD IL
60544-1067
US

V. Phone/Fax

Practice location:
  • Phone: 815-267-1260
  • Fax:
Mailing address:
  • Phone: 815-267-1260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ELIA OLIVARES
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 630-212-2712