Provider Demographics
NPI:1982827838
Name:PEDIATRIC SPEECH AND LANGUAGE THERAPY SERVICES
Entity Type:Organization
Organization Name:PEDIATRIC SPEECH AND LANGUAGE THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:MICHELS
Authorized Official - Last Name:JELM
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC
Authorized Official - Phone:630-983-6104
Mailing Address - Street 1:200 E 5TH AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-3173
Mailing Address - Country:US
Mailing Address - Phone:630-983-6104
Mailing Address - Fax:630-357-0298
Practice Address - Street 1:200 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-3100
Practice Address - Country:US
Practice Address - Phone:630-983-6104
Practice Address - Fax:630-357-0298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
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 - Single Specialty