Provider Demographics
NPI:1114033768
Name:SOUTHWEST SPEECH AND HEARING
Entity Type:Organization
Organization Name:SOUTHWEST SPEECH AND HEARING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CORSO
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:708-422-7171
Mailing Address - Street 1:4400 W 95TH ST STE 304
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2659
Mailing Address - Country:US
Mailing Address - Phone:708-422-7171
Mailing Address - Fax:
Practice Address - Street 1:4400 W 95TH ST STE 304
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2659
Practice Address - Country:US
Practice Address - Phone:708-422-7171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment