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General NPI Number Information
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NPI Number | 1952725913
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Entity Type | Organization
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Legal Business Name | CHICAGO SPEECH THERAPY
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Dates
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Enumeration Date | 02/12/2014
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Last Update Date | 02/12/2014
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Provider Practice Location Address
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Address Line | 447 W SURF ST 3W
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City | CHICAGO
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State | IL
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Zip | 60657-6164
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Country | US
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Telephone | 708-227-2583
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Fax |
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Provider Business Mailing Address
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Address Line | 447 W SURF ST 3W
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City | CHICAGO
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State | IL
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Zip | 60657-6164
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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 | CCC-SLP
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Name | KARI LEIGH MACKAY
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Credential | M.A.
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Telephone | 708-227-2583
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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 | 146.011671
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License Number State | IL
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