Provider Demographics
NPI:1841557162
Name:SMALLTALK SPEECH PATHOLOGY LLC
Entity Type:Organization
Organization Name:SMALLTALK SPEECH PATHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:847-302-0294
Mailing Address - Street 1:230 NORTHGATE ST
Mailing Address - Street 2:#647
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-5600
Mailing Address - Country:US
Mailing Address - Phone:847-302-0294
Mailing Address - Fax:847-235-2110
Practice Address - Street 1:230 NORTHGATE ST
Practice Address - Street 2:#647
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-5600
Practice Address - Country:US
Practice Address - Phone:847-302-0294
Practice Address - Fax:847-245-2110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.009669235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty