Provider Demographics
NPI:1598087793
Name:NORTHSIDE SPEECH SOLUTIONS P.C.
Entity Type:Organization
Organization Name:NORTHSIDE SPEECH SOLUTIONS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HULSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-508-7565
Mailing Address - Street 1:1760 W WRIGHTWOOD AVE
Mailing Address - Street 2:315
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1945
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1760 W WRIGHTWOOD AVE
Practice Address - Street 2:315
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1945
Practice Address - Country:US
Practice Address - Phone:317-508-7565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-16
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
IL146.009511251E00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No251E00000XAgenciesHome Health
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Single Specialty