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General NPI Number Information
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NPI Number | 1679052013
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Entity Type | Organization
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Legal Business Name | KIDS OUT LOUD PEDIATRIC THERAPY
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Dates
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Enumeration Date | 08/07/2018
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Last Update Date | 08/07/2018
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Provider Practice Location Address
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Address Line | 2311 W MONTROSE AVE UNIT 1
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City | CHICAGO
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State | IL
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Zip | 60618-1618
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Country | US
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Telephone | 773-587-9178
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Fax |
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Provider Business Mailing Address
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Address Line | 2311 W MONTROSE AVE UNIT 1
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City | CHICAGO
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State | IL
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Zip | 60618-1618
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Country | US
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Telephone | 773-587-9178
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MEGAN M DRUECK
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Credential | CCC, SLP/L
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Telephone | 773-587-9178
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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 | 146010551
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License Number State | IL
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