Provider Demographics
NPI:1114642659
Name:NORTHSHORE SPEECH THERAPY LLC
Entity Type:Organization
Organization Name:NORTHSHORE SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:DEANNE
Authorized Official - Last Name:TASIOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:BS, MS CCC-SLP/L
Authorized Official - Phone:847-946-7609
Mailing Address - Street 1:1100 ANDERSON DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-4508
Mailing Address - Country:US
Mailing Address - Phone:847-946-7609
Mailing Address - Fax:
Practice Address - Street 1:1880 W WINCHESTER RD STE 201
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5336
Practice Address - Country:US
Practice Address - Phone:312-970-0208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHSHORE SPEECH THERAPY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL15715976OtherCAQH