Provider Demographics
NPI:1659740306
Name:EMPOWERING LIGHT LANGUAGE INC
Entity Type:Organization
Organization Name:EMPOWERING LIGHT LANGUAGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SIRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:847-567-4978
Mailing Address - Street 1:1851 W GREENLEAF AVE
Mailing Address - Street 2:#1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-2303
Mailing Address - Country:US
Mailing Address - Phone:847-567-4978
Mailing Address - Fax:
Practice Address - Street 1:1851 W GREENLEAF AVE
Practice Address - Street 2:#1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-2303
Practice Address - Country:US
Practice Address - Phone:847-567-4978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146009236251E00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1457672644Medicaid