Provider Demographics
NPI:1205079704
Name:AA SPEECH LINK
Entity type:Organization
Organization Name:AA SPEECH LINK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:BESSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTONOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:773-206-7997
Mailing Address - Street 1:850 N STATE ST
Mailing Address - Street 2:2E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-8665
Mailing Address - Country:US
Mailing Address - Phone:773-206-7997
Mailing Address - Fax:312-787-6371
Practice Address - Street 1:850 N STATE ST
Practice Address - Street 2:2E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-8665
Practice Address - Country:US
Practice Address - Phone:773-206-7997
Practice Address - Fax:312-787-6371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.008154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty