Provider Demographics
NPI:1467525832
Name:SUBURBAN PEDIATRIC THERAPIES
Entity Type:Organization
Organization Name:SUBURBAN PEDIATRIC THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SUDLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-236-7000
Mailing Address - Street 1:3965 75TH ST
Mailing Address - Street 2:STE 104
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7913
Mailing Address - Country:US
Mailing Address - Phone:630-236-7000
Mailing Address - Fax:
Practice Address - Street 1:3965 75TH ST
Practice Address - Street 2:STE 104
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-7913
Practice Address - Country:US
Practice Address - Phone:630-236-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
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