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General NPI Number Information
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NPI Number | 1821255795
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Entity Type | Organization
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Legal Business Name | DIRECT SPEECH SERVICES
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Dates
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Enumeration Date | 05/19/2008
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Last Update Date | 05/19/2008
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Provider Practice Location Address
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Address Line | 741 LINCOLN LN
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City | FRANKFORT
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State | IL
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Zip | 60423-1029
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Country | US
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Telephone | 708-250-6283
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Fax |
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Provider Business Mailing Address
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Address Line | 741 LINCOLN LN
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City | FRANKFORT
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State | IL
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Zip | 60423-1029
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Country | US
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Telephone |
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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 | MR. JACQUES HAWKINS
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Credential | CCC-SLP
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Telephone | 708-250-6283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 146.008998
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License Number State | IL
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