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General NPI Number Information
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NPI Number | 1215888193
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Entity Type | Organization
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Legal Business Name | THRIVE KIDS SPEECH THERAPY LLC
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Dates
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Enumeration Date | 02/05/2026
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Last Update Date | 02/05/2026
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Provider Practice Location Address
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Address Line | 10733 REVERE RD
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City | MOKENA
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State | IL
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Zip | 60448-1903
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Country | US
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Telephone | 708-837-8869
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Fax | 708-694-7006
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Provider Business Mailing Address
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Address Line | 10733 REVERE RD
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City | MOKENA
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State | IL
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Zip | 60448-1903
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Country | US
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Telephone | 708-837-8869
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Fax | 708-694-7006
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | TAYLOR KIMBROUGH
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Credential | MS, CCC-SLP/L
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Telephone | 708-837-8869
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number |
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License Number State |
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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 |
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