Provider Demographics
NPI:1114081676
Name:S&S SPEECH AND HEARING
Entity Type:Organization
Organization Name:S&S SPEECH AND HEARING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DACHEPALLI
Authorized Official - Middle Name:
Authorized Official - Last Name:SRINIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-366-7177
Mailing Address - Street 1:PO BOX 616
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-0616
Mailing Address - Country:US
Mailing Address - Phone:708-366-7177
Mailing Address - Fax:708-366-3301
Practice Address - Street 1:2309 PROVIDENCE CT
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-3124
Practice Address - Country:US
Practice Address - Phone:708-366-7177
Practice Address - Fax:708-366-3301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty