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General NPI Number Information
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NPI Number | 1467595652
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Entity Type | Organization
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Legal Business Name | AVNI SPEECH THERAPY P.C.
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4711 N DOVER ST #2
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City | CHICAGO
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State | IL
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Zip | 60640-4687
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Country | US
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Telephone | 773-502-6225
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Fax | 773-561-6554
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Provider Business Mailing Address
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Address Line | 4711 N DOVER ST #2
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City | CHICAGO
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State | IL
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Zip | 60640-4687
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Country | US
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Telephone | 773-502-6225
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Fax | 773-561-6554
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Authorized Official
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Title or Position | PRESIDENT
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Name | TAMAR A LOSEV
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Credential | M.A.CCC-SLP
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Telephone | 773-502-6225
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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 | IL
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