=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689745812
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPEECH IN THE CITY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2006
-----------------------------------------------------
Last Update Date | 08/16/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2105 N SOUTHPORT AVE UNIT 202
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60614-4044
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-388-8918
-----------------------------------------------------
Fax | 773-388-8914
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2105 N SOUTHPORT AVE UNIT 202
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60614-4044
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax | 773-388-8914
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, SPEECH-PATHOLOGIST
-----------------------------------------------------
Name | TERRI E GARTENBERG
-----------------------------------------------------
Credential | PHD, CCC-SLP
-----------------------------------------------------
Telephone | 773-388-8918
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------