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General NPI Number Information
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NPI Number | 1780385559
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE SPEECH THERAPY, PLLC
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Dates
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Enumeration Date | 03/16/2023
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Last Update Date | 03/16/2023
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Provider Practice Location Address
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Address Line | 203 W MAIN ST
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City | ROCKTON
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State | IL
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Zip | 61072-2418
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Country | US
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Telephone | 815-957-0099
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Fax |
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Provider Business Mailing Address
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Address Line | 203 W MAIN ST
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City | ROCKTON
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State | IL
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Zip | 61072-2418
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Country | US
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Telephone | 815-957-0099
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Fax |
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Authorized Official
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Title or Position | OWNER/SPEECH LANGUAGE PATHOLOGIST
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Name | STEFANIE MCWILLIAMS
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Credential | M.S., CCC-SLP
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Telephone | 815-509-1995
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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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