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General NPI Number Information
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NPI Number | 1699004986
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Entity Type | Organization
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Legal Business Name | SPEAK UP, LLC
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Dates
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Enumeration Date | 12/15/2009
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Last Update Date | 12/15/2009
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Provider Practice Location Address
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Address Line | 6036 N OLYMPIA AVE
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City | CHICAGO
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State | IL
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Zip | 60631-3847
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Country | US
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Telephone | 847-609-0524
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Fax |
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Provider Business Mailing Address
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Address Line | 6036 N OLYMPIA AVE
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City | CHICAGO
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State | IL
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Zip | 60631-3847
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Country | US
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Telephone | 847-609-0524
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Fax |
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Authorized Official
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Title or Position | PRIMARY MEMBER
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Name | DIANE M VASILEVICH
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Credential |
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Telephone | 847-609-0524
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 146005861
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License Number State | IL
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