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General NPI Number Information
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NPI Number | 1942809231
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Entity Type | Organization
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Legal Business Name | PROGRESS TO SUCCESS SPEECH THERAPY PLLC
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Dates
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Enumeration Date | 10/19/2020
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Last Update Date | 10/26/2020
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Provider Practice Location Address
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Address Line | 4940 WILDERNESS PT
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City | SMITHTON
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State | IL
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Zip | 62285-3664
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Country | US
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Telephone | 618-719-1582
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Fax |
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Provider Business Mailing Address
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Address Line | 4940 WILDERNESS PT
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City | SMITHTON
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State | IL
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Zip | 62285-3664
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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 | AUTHORIZED OFFICIAL
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Name | KELSEY SULLIVAN
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Credential | M.S., CCC-SLP
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Telephone | 618-719-1582
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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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