Provider Demographics
NPI:1376267831
Name:TRESTLE THERAPY GROUP, PLLC
Entity Type:Organization
Organization Name:TRESTLE THERAPY GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER, MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:COONEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP, COM
Authorized Official - Phone:773-841-8180
Mailing Address - Street 1:4560 W 103RD ST STE 2
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-4870
Mailing Address - Country:US
Mailing Address - Phone:708-581-5798
Mailing Address - Fax:
Practice Address - Street 1:4560 W 103RD ST STE 2
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4870
Practice Address - Country:US
Practice Address - Phone:708-581-5798
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-28
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty