Provider Demographics
NPI:1609975507
Name:INTERACTIVE SPEECH ASSOCIATES
Entity Type:Organization
Organization Name:INTERACTIVE SPEECH ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:IZQUIERDO
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:847-982-5126
Mailing Address - Street 1:8340 LINCOLN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-2466
Mailing Address - Country:US
Mailing Address - Phone:847-982-5126
Mailing Address - Fax:
Practice Address - Street 1:8340 LINCOLN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2466
Practice Address - Country:US
Practice Address - Phone:847-982-5126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
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