Provider Demographics
NPI:1518345651
Name:SPEECH AND LITERACY THERAPY CENTER
Entity Type:Organization
Organization Name:SPEECH AND LITERACY THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:JOSEPHINE
Authorized Official - Last Name:TUNGET
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:618-534-1860
Mailing Address - Street 1:1300 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-2947
Mailing Address - Country:US
Mailing Address - Phone:618-534-1860
Mailing Address - Fax:
Practice Address - Street 1:1300 N STATE ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-2947
Practice Address - Country:US
Practice Address - Phone:618-534-1860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-08
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146011064235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty