Provider Demographics
NPI:1851805410
Name:JAMIE TRAILOV SPEECH PATHOLOGY, P.C.
Entity Type:Organization
Organization Name:JAMIE TRAILOV SPEECH PATHOLOGY, P.C.
Other - Org Name:LET'S TALK SPEECH & LANGUAGE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAILOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-460-4663
Mailing Address - Street 1:1041 W WOLFRAM ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4327
Mailing Address - Country:US
Mailing Address - Phone:630-460-4663
Mailing Address - Fax:
Practice Address - Street 1:1041 W WOLFRAM ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4327
Practice Address - Country:US
Practice Address - Phone:630-460-4663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-18
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060.012178235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty