Provider Demographics
NPI:1205036910
Name:SPEECH AND LANGUAGE ACADEMY, INC.
Entity Type:Organization
Organization Name:SPEECH AND LANGUAGE ACADEMY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:MCLAMORE
Authorized Official - Last Name:NOWAK
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP/L
Authorized Official - Phone:708-205-9679
Mailing Address - Street 1:5212 FAIR ELMS AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-1810
Mailing Address - Country:US
Mailing Address - Phone:708-205-9679
Mailing Address - Fax:708-839-4325
Practice Address - Street 1:5212 FAIR ELMS AVE
Practice Address - Street 2:
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-1810
Practice Address - Country:US
Practice Address - Phone:708-205-9679
Practice Address - Fax:708-839-4325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146007765235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty