Healthcare Provider Details

I. General information

NPI: 1578794558
Provider Name (Legal Business Name): SPEECH TREE ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2009
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 CHATHAM RD STE A
SPRINGFIELD IL
62704-5379
US

IV. Provider business mailing address

PO BOX 631278
CINCINNATI OH
45263-1278
US

V. Phone/Fax

Practice location:
  • Phone: 815-725-9992
  • Fax: 847-584-2604
Mailing address:
  • Phone: 815-725-9992
  • Fax: 847-584-2604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: JULIE BUSH
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 847-584-2604