Provider Demographics
NPI:1679671788
Name:SWEET PEA THERAPY SERVICES LTD
Entity Type:Organization
Organization Name:SWEET PEA THERAPY SERVICES LTD
Other - Org Name:SWEET PEA THERAPY SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER SPEECH LANG PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC SLPL
Authorized Official - Phone:815-545-3577
Mailing Address - Street 1:752 COLUMBIA
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451
Mailing Address - Country:US
Mailing Address - Phone:815-545-3577
Mailing Address - Fax:815-462-2620
Practice Address - Street 1:752 COLUMBIA
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451
Practice Address - Country:US
Practice Address - Phone:815-545-3577
Practice Address - Fax:815-462-2620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9932457OtherBCBS ID #