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General NPI Number Information
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NPI Number | 1265556534
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Entity Type | Organization
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Legal Business Name | CENTRAL SPEECH AND LANGUAGE CLINIC, INC.
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4160 IL ROUTE 83 SUITE 101
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City | LONG GROVE
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State | IL
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Zip | 60047-5083
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Country | US
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Telephone | 847-821-1237
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Fax | 847-276-2743
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Provider Business Mailing Address
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Address Line | 4160 IL ROUTE 83 SUITE 101
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City | LONG GROVE
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State | IL
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Zip | 60047-5083
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Country | US
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Telephone | 847-821-1237
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Fax | 847-276-2743
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | KAREN M GONZALEZ
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Credential | M.S., CCC-SLP
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Telephone | 847-821-1237
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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 |
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