Provider Demographics
NPI:1962834523
Name:SPEECH & LANGUAGE DEVELOPMENT CENTER
Entity Type:Organization
Organization Name:SPEECH & LANGUAGE DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CHEAK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:618-351-0444
Mailing Address - Street 1:800 E WALNUT ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-3142
Mailing Address - Country:US
Mailing Address - Phone:618-351-0444
Mailing Address - Fax:618-351-0448
Practice Address - Street 1:800 E WALNUT ST
Practice Address - Street 2:SUITE A
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-3142
Practice Address - Country:US
Practice Address - Phone:618-351-0444
Practice Address - Fax:618-351-0448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty