Provider Demographics
NPI:1851381909
Name:MOSAIC CHILDHOOD PROJECT, INC.
Entity Type:Organization
Organization Name:MOSAIC CHILDHOOD PROJECT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:LARA
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC/SLP
Authorized Official - Phone:773-575-6215
Mailing Address - Street 1:525 W ALDINE AVE
Mailing Address - Street 2:604
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3775
Mailing Address - Country:US
Mailing Address - Phone:773-575-6215
Mailing Address - Fax:
Practice Address - Street 1:525 W ALDINE AVE
Practice Address - Street 2:604
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3775
Practice Address - Country:US
Practice Address - Phone:773-575-6215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty