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General NPI Number Information
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NPI Number | 1710128640
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Entity Type | Organization
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Legal Business Name | S AND S SPEECH AND HEARING
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Dates
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Enumeration Date | 03/24/2009
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Last Update Date | 04/20/2009
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Provider Practice Location Address
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Address Line | 7530 WOODWARD AVE SUITE A
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City | WOODRIDGE
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State | IL
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Zip | 60517-3100
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Country | US
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Telephone | 630-267-1869
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Fax | 630-416-0374
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Provider Business Mailing Address
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Address Line | 7530 WOODWARD AVE SUITE A
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City | WOODRIDGE
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State | IL
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Zip | 60517-3100
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Country | US
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Telephone | 630-267-1869
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Fax | 630-416-0374
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Authorized Official
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Title or Position | AUDIOLOGIST
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Name | MR. DACHEPALLI CHANDRA SRINIVAS
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Credential | MSC
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Telephone | 630-267-1869
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 147001152
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License Number State | IL
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