Provider Demographics
NPI:1285207068
Name:WONDERBUS SPEECH THERAPY LLC
Entity Type:Organization
Organization Name:WONDERBUS SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH AND LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAYLENE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:OESTERREICH
Authorized Official - Suffix:
Authorized Official - Credentials:CCC/SLP
Authorized Official - Phone:847-508-5861
Mailing Address - Street 1:25136 PATRIOT CT
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-2594
Mailing Address - Country:US
Mailing Address - Phone:847-508-5861
Mailing Address - Fax:
Practice Address - Street 1:25136 PATRIOT CT
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-2594
Practice Address - Country:US
Practice Address - Phone:847-508-5861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty