Provider Demographics
NPI:1235273756
Name:DRISCOLL PEDIATRIC SPEECH SERVICES, INC.
Entity Type:Organization
Organization Name:DRISCOLL PEDIATRIC SPEECH SERVICES, INC.
Other - Org Name:AMANDA DRISCOLL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DRISCOLL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:815-342-7957
Mailing Address - Street 1:7709 CATALPA DR
Mailing Address - Street 2:
Mailing Address - City:WONDER LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60097-9259
Mailing Address - Country:US
Mailing Address - Phone:815-342-7957
Mailing Address - Fax:815-653-4842
Practice Address - Street 1:7709 CATALPA DR
Practice Address - Street 2:
Practice Address - City:WONDER LAKE
Practice Address - State:IL
Practice Address - Zip Code:60097-9259
Practice Address - Country:US
Practice Address - Phone:815-342-7957
Practice Address - Fax:815-653-4842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty