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General NPI Number Information
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NPI Number | 1245351642
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Entity Type | Organization
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Legal Business Name | GL SPEECH ASSOCIATES LTD
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 03/15/2013
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Provider Practice Location Address
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Address Line | 900 SKOKIE BLVD STE 215
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City | NORTHBROOK
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State | IL
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Zip | 60062-4012
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Country | US
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Telephone | 847-564-9230
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Fax | 847-564-9258
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Provider Business Mailing Address
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Address Line | 900 SKOKIE BLVD STE 215
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City | NORTHBROOK
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State | IL
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Zip | 60062-4012
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Country | US
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Telephone | 847-564-9230
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Fax | 847-564-9258
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN LYBOLT
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Credential | PH.D.
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Telephone | 847-564-9230
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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 | 146003355
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License Number State | IL
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