Provider Demographics
NPI:1093196370
Name:TALKTIME PEDIATRIC SPEECH ACADEMY, INC
Entity Type:Organization
Organization Name:TALKTIME PEDIATRIC SPEECH ACADEMY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH/LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BASEL
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC/SLP
Authorized Official - Phone:815-353-9527
Mailing Address - Street 1:1302 LILAC LN
Mailing Address - Street 2:
Mailing Address - City:HARVARD
Mailing Address - State:IL
Mailing Address - Zip Code:60033-3722
Mailing Address - Country:US
Mailing Address - Phone:815-943-3439
Mailing Address - Fax:815-337-7583
Practice Address - Street 1:1575 W LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-6917
Practice Address - Country:US
Practice Address - Phone:815-353-9527
Practice Address - Fax:815-337-7583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-12
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.004443235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01094374OtherASHA CERTIFICATION STATUS
IL146.004443OtherLICENSE NUMBER