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General NPI Number Information
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NPI Number | 1043027105
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Entity Type | Organization
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Legal Business Name | ACHIEVE SPEECH THERAPY, PLLC
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Dates
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Enumeration Date | 12/12/2024
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 3701 E LAKE CTR STE 4
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City | QUINCY
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State | IL
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Zip | 62305-5854
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Country | US
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Telephone | 217-209-1748
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Fax | 888-919-3363
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Provider Business Mailing Address
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Address Line | 3701 E LAKE CTR STE 4
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City | QUINCY
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State | IL
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Zip | 62305-5854
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Country | US
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Telephone | 217-209-1748
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Fax | 888-919-3363
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Authorized Official
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Title or Position | OWNER/SPEECH LANGUAGE PATHOLOGIST
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Name | MACKENZI JO TALLCOTT
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Credential | MS, CCC-SLP
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Telephone | 217-209-1748
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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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