Healthcare Provider Details

I. General information

NPI: 1598492811
Provider Name (Legal Business Name): SPEECH AND ME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1254 HARLEYFORD RD
WOODRIDGE IL
60517-7529
US

IV. Provider business mailing address

1254 HARLEYFORD RD
WOODRIDGE IL
60517-7529
US

V. Phone/Fax

Practice location:
  • Phone: 818-424-9310
  • Fax:
Mailing address:
  • Phone: 818-424-9310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SANTINA YACOUB
Title or Position: PREDENT
Credential:
Phone: 818-424-9310