Provider Demographics
NPI:1710183207
Name:WEST SUBURBAN SPEECH CLINIC
Entity Type:Organization
Organization Name:WEST SUBURBAN SPEECH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HUBATCH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, CCC
Authorized Official - Phone:630-932-4599
Mailing Address - Street 1:1S224 SUMMIT AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-3983
Mailing Address - Country:US
Mailing Address - Phone:630-932-4599
Mailing Address - Fax:630-426-9102
Practice Address - Street 1:1S224 SUMMIT AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-3983
Practice Address - Country:US
Practice Address - Phone:630-932-4599
Practice Address - Fax:630-426-9102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.003248235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty