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General NPI Number Information
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NPI Number | 1891017901
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Entity Type | Organization
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Legal Business Name | INSTITUTE OF ACCENT MODIFICATION, INC.
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Dates
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Enumeration Date | 02/17/2010
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Last Update Date | 03/08/2010
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Provider Practice Location Address
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Address Line | 125 S WACKER DR SUITE 300
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City | CHICAGO
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State | IL
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Zip | 60606-4424
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Country | US
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Telephone | 312-635-0099
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Fax | 888-203-5297
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Provider Business Mailing Address
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Address Line | 28 E JACKSON BLVD SUITE #10-A850
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City | CHICAGO
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State | IL
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Zip | 60604-2263
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Country | US
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Telephone | 312-635-0099
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Fax | 888-203-5297
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. TRACEY INGRAM
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Credential | M.A., M.S
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Telephone | 312-635-0099
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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 | 147000563
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License Number State | IL
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