Provider Demographics
NPI:1851688360
Name:COMPREHENSIVE SPEECH AND LANGUAGE PATHOLOGY LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE SPEECH AND LANGUAGE PATHOLOGY LLC
Other - Org Name:MARA H LANE MS CCC SLP
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR SPEECH LANGUAGE PATHOLOGIS
Authorized Official - Prefix:MS
Authorized Official - First Name:MARA
Authorized Official - Middle Name:H
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC SLP
Authorized Official - Phone:847-945-8977
Mailing Address - Street 1:140 GREENBRIAR EAST DR
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-5064
Mailing Address - Country:US
Mailing Address - Phone:847-945-8977
Mailing Address - Fax:847-945-3646
Practice Address - Street 1:140 GREENBRIAR EAST DR
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5064
Practice Address - Country:US
Practice Address - Phone:847-945-8977
Practice Address - Fax:847-945-3646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty