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General NPI Number Information
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NPI Number | 1841069796
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Entity Type | Organization
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Legal Business Name | PARK RIDGE SPEECH THERAPY LLC
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Dates
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Enumeration Date | 12/20/2023
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Last Update Date | 12/20/2023
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Provider Practice Location Address
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Address Line | 206 N MERRILL ST
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City | PARK RIDGE
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State | IL
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Zip | 60068-3526
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Country | US
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Telephone | 847-840-0139
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Fax |
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Provider Business Mailing Address
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Address Line | 206 N MERRILL ST
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City | PARK RIDGE
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State | IL
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Zip | 60068-3526
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Country | US
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Telephone | 847-840-0139
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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 | OLIVIA M HALLAGAN
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Credential | MS, CCC-SLP
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Telephone | 847-840-0139
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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 |
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License Number State |
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