Provider Demographics
NPI:1255671855
Name:SMALL TALK COMMUNICATION LLC
Entity Type:Organization
Organization Name:SMALL TALK COMMUNICATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSCCC/SLP
Authorized Official - Phone:708-466-4111
Mailing Address - Street 1:14637 STONEHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-3483
Mailing Address - Country:US
Mailing Address - Phone:708-466-4111
Mailing Address - Fax:708-645-5687
Practice Address - Street 1:14637 STONEHAVEN LN
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-3483
Practice Address - Country:US
Practice Address - Phone:708-466-4111
Practice Address - Fax:708-645-5687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.006284252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency