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General NPI Number Information
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NPI Number | 1154784791
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Entity Type | Organization
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Legal Business Name | SECOND CITY SPEECH, LLC
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Dates
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Enumeration Date | 03/31/2016
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Last Update Date | 08/26/2016
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Provider Practice Location Address
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Address Line | 4120 W FLETCHER ST
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City | CHICAGO
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State | IL
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Zip | 60641-5431
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Country | US
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Telephone | 317-225-8349
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Fax |
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Provider Business Mailing Address
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Address Line | 1520 N DAMEN AVE SUITE D, OFFICE #4
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City | CHICAGO
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State | IL
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Zip | 60622-1967
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Country | US
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Telephone | 317-225-8349
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARISSA CLAIRE ARTMAN
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Credential |
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Telephone | 317-225-8349
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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 | 146011927
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License Number State | IL
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