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General NPI Number Information
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NPI Number | 1013726009
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Entity Type | Organization
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Legal Business Name | PEACH COAST THERAPY LLC
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Dates
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Enumeration Date | 01/03/2025
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 5616 N KENMORE AVE APT 3A
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City | CHICAGO
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State | IL
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Zip | 60660-4609
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Country | US
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Telephone | 412-512-9469
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Fax |
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Provider Business Mailing Address
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Address Line | 5616 N KENMORE AVE APT 3A
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City | CHICAGO
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State | IL
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Zip | 60660-4609
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Country | US
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Telephone | 412-512-9469
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Fax |
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Authorized Official
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Title or Position | REGISTERED AGENT
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Name | ELIZABETH STENGER
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Credential | M.S. CCC-SLP
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Telephone | 412-512-9469
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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 |
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License Number State |
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