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General NPI Number Information
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NPI Number | 1093196370
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Entity Type | Organization
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Legal Business Name | TALKTIME PEDIATRIC SPEECH ACADEMY, INC
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Dates
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Enumeration Date | 06/12/2015
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Last Update Date | 06/12/2015
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Provider Practice Location Address
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Address Line | 1575 W LAKE SHORE DR
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City | WOODSTOCK
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State | IL
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Zip | 60098-6917
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Country | US
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Telephone | 815-353-9527
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Fax | 815-337-7583
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Provider Business Mailing Address
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Address Line | 1302 LILAC LN
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City | HARVARD
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State | IL
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Zip | 60033-3722
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Country | US
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Telephone | 815-943-3439
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Fax | 815-337-7583
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Authorized Official
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Title or Position | SPEECH/LANGUAGE PATHOLOGIST
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Name | TAMMY LYNN BASEL
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Credential | MS CCC/SLP
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Telephone | 815-353-9527
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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 | 146.004443
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License Number State | IL
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