Provider Demographics
NPI:1083860670
Name:ICS REHAB LLC
Entity Type:Organization
Organization Name:ICS REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH THERAPIST/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IFY
Authorized Official - Middle Name:C
Authorized Official - Last Name:SLOAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS,SLP,CCC/L
Authorized Official - Phone:708-519-0786
Mailing Address - Street 1:1104 N TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1146
Mailing Address - Country:US
Mailing Address - Phone:708-519-0786
Mailing Address - Fax:708-368-6727
Practice Address - Street 1:1104 N TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1146
Practice Address - Country:US
Practice Address - Phone:708-519-0786
Practice Address - Fax:708-386-4351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty