Provider Demographics
NPI:1710128640
Name:S AND S SPEECH AND HEARING
Entity Type:Organization
Organization Name:S AND S SPEECH AND HEARING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DACHEPALLI
Authorized Official - Middle Name:CHANDRA
Authorized Official - Last Name:SRINIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:MSC
Authorized Official - Phone:630-267-1869
Mailing Address - Street 1:7530 WOODWARD AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-3100
Mailing Address - Country:US
Mailing Address - Phone:630-267-1869
Mailing Address - Fax:630-416-0374
Practice Address - Street 1:7530 WOODWARD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-3100
Practice Address - Country:US
Practice Address - Phone:630-267-1869
Practice Address - Fax:630-416-0374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-24
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147001152174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL146008136OtherLICENSE NUMBER
IL147001152OtherLICENSE NUMBER