Provider Demographics
NPI:1386826220
Name:DHOM SPEECH THERAPY SERVICES, P.C.
Entity Type:Organization
Organization Name:DHOM SPEECH THERAPY SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DHOM
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:847-722-0421
Mailing Address - Street 1:4889 N ASHLAND AVE APT 1W
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-3433
Mailing Address - Country:US
Mailing Address - Phone:847-722-0421
Mailing Address - Fax:773-275-6347
Practice Address - Street 1:4889 N ASHLAND AVE APT 1W
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-3433
Practice Address - Country:US
Practice Address - Phone:847-722-0421
Practice Address - Fax:773-275-6347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency