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General NPI Number Information
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NPI Number | 1184029407
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Entity Type | Organization
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Legal Business Name | THE LARYNX INSTITUTE
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Dates
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Enumeration Date | 10/29/2014
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Last Update Date | 10/29/2014
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Provider Practice Location Address
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Address Line | 3402 W LEXINGTON ST 1ST FLOOR
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City | CHICAGO
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State | IL
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Zip | 60624-4132
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Country | US
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Telephone | 773-750-9865
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Fax |
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Provider Business Mailing Address
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Address Line | 3402 W LEXINGTON ST 1ST FLOOR
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City | CHICAGO
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State | IL
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Zip | 60624-4132
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | TIFFANY TIEASHA BURKETT
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Credential | MS,CCC-SLP
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Telephone | 773-750-9865
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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 | 146.00008425
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License Number State | IL
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