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General NPI Number Information
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NPI Number | 1619546140
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Entity Type | Organization
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Legal Business Name | LAKE CITY SPEECH & VOICE THERAPY, PLLC
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Dates
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Enumeration Date | 06/19/2021
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Last Update Date | 06/19/2021
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Provider Practice Location Address
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Address Line | 2159 W FARRAGUT AVE
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City | CHICAGO
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State | IL
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Zip | 60625-1203
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Country | US
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Telephone | 773-234-2349
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Fax |
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Provider Business Mailing Address
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Address Line | 2159 W FARRAGUT AVE
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City | CHICAGO
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State | IL
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Zip | 60625-1203
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Country | US
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Telephone | 773-234-2349
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Fax |
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | MS. CARRIE MCBREEN
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Credential | MS CCC-SLP
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Telephone | 773-234-2349
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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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