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General NPI Number Information
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NPI Number | 1255411005
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Entity Type | Organization
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Legal Business Name | SURE START DEVELOPMENTAL SERVICES, INC.
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 08/04/2011
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Provider Practice Location Address
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Address Line | 919 N WOLCOTT AVE #201
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City | CHICAGO
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State | IL
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Zip | 60622-7229
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Country | US
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Telephone | 773-398-7873
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Fax | 773-435-6734
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Provider Business Mailing Address
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Address Line | 919 N WOLCOTT AVE #201
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City | CHICAGO
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State | IL
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Zip | 60622-7229
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Country | US
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Telephone | 773-398-7873
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Fax | 773-435-6734
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Authorized Official
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Title or Position | SPEECH AND LANGUAGE PATHOLOGIST
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Name | CARRYL SHER
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Credential | MA CCC-SLP/L
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Telephone | 773-398-7873
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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 | 146005299
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License Number State | IL
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