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General NPI Number Information
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NPI Number | 1992123087
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Entity Type | Organization
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Legal Business Name | SPEECH IRL, LLC
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Dates
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Enumeration Date | 04/04/2014
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Last Update Date | 07/10/2014
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Provider Practice Location Address
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Address Line | 73 W MONROE ST #227
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City | CHICAGO
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State | IL
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Zip | 60603-4910
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Country | US
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Telephone | 312-870-0352
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Fax |
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Provider Business Mailing Address
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Address Line | 73 W MONROE ST # 227
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City | CHICAGO
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State | IL
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Zip | 60603-4910
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Country | US
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Telephone | 312-870-0352
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Fax | 312-650-8208
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Authorized Official
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Title or Position | DIRECTOR
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Name | KATIE GORE
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Credential | MA, CCC-SLP
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Telephone | 312-870-0352
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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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