Provider Demographics
NPI:1659525301
Name:PEDIATRIC ADULT REHABILITATION ASSOCIATES
Entity Type:Organization
Organization Name:PEDIATRIC ADULT REHABILITATION ASSOCIATES
Other - Org Name:SPEECH TREE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAUNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUZICH
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC SLP
Authorized Official - Phone:815-725-9992
Mailing Address - Street 1:2423 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5483
Mailing Address - Country:US
Mailing Address - Phone:815-725-9992
Mailing Address - Fax:815-725-9993
Practice Address - Street 1:2423 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5483
Practice Address - Country:US
Practice Address - Phone:815-725-9992
Practice Address - Fax:815-725-9993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242001067235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty