Provider Demographics
NPI:1174632186
Name:SQUARE ONE KIDS, LLC
Entity Type:Organization
Organization Name:SQUARE ONE KIDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:773-343-8484
Mailing Address - Street 1:9736 S HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-1644
Mailing Address - Country:US
Mailing Address - Phone:773-343-8484
Mailing Address - Fax:773-305-0954
Practice Address - Street 1:9736 S HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-1644
Practice Address - Country:US
Practice Address - Phone:773-343-8484
Practice Address - Fax:773-305-0954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty