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General NPI Number Information
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NPI Number | 1023544731
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Entity Type | Organization
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Legal Business Name | SPEAK CHICAGO PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 05/02/2017
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Last Update Date | 05/02/2017
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Provider Practice Location Address
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Address Line | 25 E WASHINGTON ST SUITE 1908
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City | CHICAGO
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State | IL
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Zip | 60602-1708
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Country | US
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Telephone | 312-870-0885
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Fax |
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Provider Business Mailing Address
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Address Line | 25 E WASHINGTON ST SUITE 1908
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City | CHICAGO
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State | IL
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Zip | 60602-1708
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Country | US
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Telephone | 312-870-0885
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MRS. ASYA BRODSKY
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Credential | LCSW, CADC
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Telephone | 312-870-0885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.017085
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License Number State | IL
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