Provider Demographics
NPI:1376928689
Name:LIGHT STREET EI, LLC
Entity Type:Organization
Organization Name:LIGHT STREET EI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MALONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-369-0000
Mailing Address - Street 1:3600 CLIPPER MILL RD
Mailing Address - Street 2:STE 330
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-1948
Mailing Address - Country:US
Mailing Address - Phone:410-369-0000
Mailing Address - Fax:
Practice Address - Street 1:2700 PATRIOT BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-8021
Practice Address - Country:US
Practice Address - Phone:815-931-8595
Practice Address - Fax:855-837-4651
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEARN-IT SYSTEMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-28
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty