Provider Demographics
NPI:1811369788
Name:SLM DEVELOPMENTAL, INC.
Entity Type:Organization
Organization Name:SLM DEVELOPMENTAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:MUHAMMAD
Authorized Official - Suffix:
Authorized Official - Credentials:DT
Authorized Official - Phone:708-953-4605
Mailing Address - Street 1:14212 COTTAGE GROVE AVE UNIT 52
Mailing Address - Street 2:
Mailing Address - City:DOLTON
Mailing Address - State:IL
Mailing Address - Zip Code:60419-6004
Mailing Address - Country:US
Mailing Address - Phone:708-953-4605
Mailing Address - Fax:
Practice Address - Street 1:14212 COTTAGE GROVE AVE UNIT 52
Practice Address - Street 2:
Practice Address - City:DOLTON
Practice Address - State:IL
Practice Address - Zip Code:60419-6004
Practice Address - Country:US
Practice Address - Phone:708-953-4605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-30
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency