Provider Demographics
NPI:1124381199
Name:VBL SPEECH THERAPY SERVICES
Entity Type:Organization
Organization Name:VBL SPEECH THERAPY SERVICES
Other - Org Name:VANESSA BONNEY-LARAMORE DBA VBL SPEECH THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BONNEY-LARAMORE
Authorized Official - Suffix:
Authorized Official - Credentials:MHSCCC-SLP/L
Authorized Official - Phone:773-495-7423
Mailing Address - Street 1:8631 S FRANCISCO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60652-3834
Mailing Address - Country:US
Mailing Address - Phone:773-495-7423
Mailing Address - Fax:
Practice Address - Street 1:8631 S FRANCISCO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60652-3834
Practice Address - Country:US
Practice Address - Phone:773-495-7423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-24
Last Update Date:2012-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146002339235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01636471OtherBLUE SHIELD PROVIDER NUMBER