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General NPI Number Information
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NPI Number | 1730754862
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Entity Type | Organization
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Legal Business Name | CORAL PEDIATRIC THERAPY LLC
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Dates
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Enumeration Date | 05/21/2021
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Last Update Date | 05/21/2021
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Provider Practice Location Address
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Address Line | 558 RUSSELL RD
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City | DEKALB
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State | IL
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Zip | 60115
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Country | US
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Telephone | 815-201-2507
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Fax |
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Provider Business Mailing Address
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Address Line | 3230 SYCAMORE RD STE 164
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City | DEKALB
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State | IL
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Zip | 60115-9621
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Country | US
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Telephone | 815-201-2507
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Fax |
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | NORMA LAURA GREGORIO-PEREZ
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Credential | CCC-SLP/L
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Telephone | 815-201-2507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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