Provider Demographics
NPI:1467595652
Name:AVNI SPEECH THERAPY P.C.
Entity Type:Organization
Organization Name:AVNI SPEECH THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAMAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOSEV
Authorized Official - Suffix:
Authorized Official - Credentials:MACCC-SLP
Authorized Official - Phone:773-502-6225
Mailing Address - Street 1:4711 N DOVER ST
Mailing Address - Street 2:#2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-4687
Mailing Address - Country:US
Mailing Address - Phone:773-502-6225
Mailing Address - Fax:773-561-6554
Practice Address - Street 1:4711 N DOVER ST
Practice Address - Street 2:#2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-4687
Practice Address - Country:US
Practice Address - Phone:773-502-6225
Practice Address - Fax:773-561-6554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
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 - Single Specialty