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General NPI Number Information
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NPI Number | 1174652614
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Entity Type | Organization
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Legal Business Name | OAK TREE DEVELOPMENTAL CENTER
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1640 N WELLS ST UNIT 103
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City | CHICAGO
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State | IL
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Zip | 60614-6006
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Country | US
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Telephone | 312-642-4300
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Fax | 312-642-4302
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Provider Business Mailing Address
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Address Line | 1640 N WELLS ST UNIT 103
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City | CHICAGO
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State | IL
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Zip | 60614-6006
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Country | US
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Telephone | 312-642-4300
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Fax | 312-642-4302
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Authorized Official
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Title or Position | SPEECH PATHOLOGIST
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Name | MS. MARY A CRUM
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Credential | MA CCC SLPL
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Telephone | 312-642-4300
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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 | IL
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Taxonomy #2
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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 | IL
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | IL
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