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General NPI Number Information
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NPI Number | 1346471315
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Entity Type | Organization
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Legal Business Name | PRECIOUS ONES SPEECH LANGUAGE THERAPY, INC.
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Dates
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Enumeration Date | 08/07/2009
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Last Update Date | 08/07/2009
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Provider Practice Location Address
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Address Line | 4240 CASTLE ROCK CIR
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City | AURORA
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State | IL
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Zip | 60504-8414
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Country | US
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Telephone | 630-631-2095
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Fax | 866-887-1597
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Provider Business Mailing Address
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Address Line | 4240 CASTLE ROCK CIR
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City | AURORA
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State | IL
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Zip | 60504-8414
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Country | US
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Telephone | 630-631-2095
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Fax | 866-887-1597
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Authorized Official
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Title or Position | PRESIDENT
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Name | NICOLETTE ROSE WOHLFAHRT
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Credential | M.S. CCC-SLP/L
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Telephone | 630-631-2095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 146.007778
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License Number State | IL
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