Provider Demographics
NPI:1376868075
Name:ADVANCEMENT TX
Entity Type:Organization
Organization Name:ADVANCEMENT TX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNISE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-430-8150
Mailing Address - Street 1:4710 LINCOLN HWY STE 263
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-2316
Mailing Address - Country:US
Mailing Address - Phone:800-430-8150
Mailing Address - Fax:
Practice Address - Street 1:122 TOWN CENTER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2251
Practice Address - Country:US
Practice Address - Phone:800-430-8150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.003214251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health