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General NPI Number Information
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NPI Number | 1710473160
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Entity Type | Organization
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Legal Business Name | SMALL TALK SPEECH SERVICES, LLC
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Dates
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Enumeration Date | 07/09/2018
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Last Update Date | 04/10/2023
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Provider Practice Location Address
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Address Line | 1600 DERBY DR
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City | BOURBONNAIS
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State | IL
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Zip | 60914-9413
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Country | US
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Telephone | 815-671-2885
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Fax |
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Provider Business Mailing Address
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Address Line | 1106 RIVERLANE DR
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City | BRADLEY
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State | IL
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Zip | 60915-1947
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Country | US
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Telephone | 815-671-2885
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Fax | 833-849-4201
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | KATIE MARIE ERICKSON-KELLER
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Credential | MS CCC-SLP
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Telephone | 815-671-2885
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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 | 146011665
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 261QA3000X
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Taxonomy Name | Augmentative Communication Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | 146011665
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License Number State | IL
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