Provider Demographics
NPI:1700417748
Name:SPEAK YOUR MIND SPEECH AND LANGUAGE PLLC
Entity Type:Organization
Organization Name:SPEAK YOUR MIND SPEECH AND LANGUAGE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LORISSA
Authorized Official - Middle Name:BERTOLINI
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:201-602-3374
Mailing Address - Street 1:1326 CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-6510
Mailing Address - Country:US
Mailing Address - Phone:201-602-3374
Mailing Address - Fax:
Practice Address - Street 1:402 E ROOSEVELT RD STE 104
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5588
Practice Address - Country:US
Practice Address - Phone:630-765-5890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty