Provider Demographics
NPI:1710473160
Name:SMALL TALK SPEECH SERVICES, LLC
Entity Type:Organization
Organization Name:SMALL TALK SPEECH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ERICKSON-KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:815-671-2885
Mailing Address - Street 1:1106 RIVERLANE DR
Mailing Address - Street 2:
Mailing Address - City:BRADLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60915-1947
Mailing Address - Country:US
Mailing Address - Phone:815-671-2885
Mailing Address - Fax:833-849-4201
Practice Address - Street 1:1600 DERBY DR
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-9413
Practice Address - Country:US
Practice Address - Phone:815-671-2885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-09
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146011665252Y00000X, 261QH0700X
261QA3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QA3000XAmbulatory Health Care FacilitiesClinic/CenterAugmentative Communication