=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437288388
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COHEN SPEECH AND FEEDING SOLUTIONS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2007
-----------------------------------------------------
Last Update Date | 01/20/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2720 DUNDEE RD #226
-----------------------------------------------------
City | NORTHBROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60062-2609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-867-5390
-----------------------------------------------------
Fax | 773-337-4709
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2720 DUNDEE RD #226
-----------------------------------------------------
City | NORTHBROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60062-2609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-867-5390
-----------------------------------------------------
Fax | 773-337-4709
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. STEPHANIE COOPER COHEN
-----------------------------------------------------
Credential | M.A., CCC-SLP
-----------------------------------------------------
Telephone | 847-867-5390
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 146-007011
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------