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General NPI Number Information
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NPI Number | 1881743789
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Entity Type | Organization
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Legal Business Name | SPEECH THERAPY SOURCE, P.C.
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 202 S DUNTON AVE
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60005-1904
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Country | US
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Telephone | 847-997-4672
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Fax | 847-259-7794
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Provider Business Mailing Address
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Address Line | 202 S DUNTON AVE
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60005-1904
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Country | US
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Telephone | 847-997-4672
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Fax | 847-259-7794
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | PETER T LYON
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Credential | M.A., CCC-SLP
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Telephone | 847-997-4672
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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 | IL
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