Provider Demographics
NPI:1295183598
Name:LANGUAGE LEGACY
Entity Type:Organization
Organization Name:LANGUAGE LEGACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EDUCATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ANNALOU
Authorized Official - Last Name:RUSH
Authorized Official - Suffix:
Authorized Official - Credentials:MALS ESL
Authorized Official - Phone:708-368-7482
Mailing Address - Street 1:PO BOX 242
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:IL
Mailing Address - Zip Code:60445-0242
Mailing Address - Country:US
Mailing Address - Phone:708-368-7482
Mailing Address - Fax:
Practice Address - Street 1:14507 PULASKI RD APT 1
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:IL
Practice Address - Zip Code:60445-2850
Practice Address - Country:US
Practice Address - Phone:708-368-7482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2338618171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty