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General NPI Number Information
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NPI Number | 1013379411
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Entity Type | Organization
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Legal Business Name | CROSSROADS SPEECH THERAPY P.C.
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Dates
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Enumeration Date | 03/24/2016
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Last Update Date | 03/24/2016
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Provider Practice Location Address
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Address Line | 1509 W ROSCOE ST
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City | CHICAGO
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State | IL
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Zip | 60657-1311
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Country | US
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Telephone | 847-924-2390
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Fax |
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Provider Business Mailing Address
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Address Line | 1509 W ROSCOE ST
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City | CHICAGO
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State | IL
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Zip | 60657-1311
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Country | US
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Telephone | 847-924-2390
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Fax |
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Authorized Official
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Title or Position | SPEECH AND LANGUAGE PATHOLOGIST
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Name | KATHERINE LORRAINE DIMOND
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Credential | MA CCC-SLP
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Telephone | 847-924-2390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 146009787
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License Number State | IL
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