Provider Demographics
NPI:1477728319
Name:CLINICAL CONNECTIONS
Entity Type:Organization
Organization Name:CLINICAL CONNECTIONS
Other - Org Name:SPEECHKIDS/OTKIDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CRISLER
Authorized Official - Middle Name:MAGOR
Authorized Official - Last Name:LOVENDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-234-0688
Mailing Address - Street 1:2225 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:BANNOCKBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1265
Mailing Address - Country:US
Mailing Address - Phone:847-234-0688
Mailing Address - Fax:847-234-0687
Practice Address - Street 1:2225 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:BANNOCKBURN
Practice Address - State:IL
Practice Address - Zip Code:60015-1265
Practice Address - Country:US
Practice Address - Phone:847-234-0688
Practice Address - Fax:847-234-0687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL54258225800000X
IL056008019225X00000X
IL146001092235Z00000X
IL146008523235Z00000X
IL146008990235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty