Provider Demographics
NPI:1255411005
Name:SURE START DEVELOPMENTAL SERVICES, INC.
Entity type:Organization
Organization Name:SURE START DEVELOPMENTAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH AND LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CARRYL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHER
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP/L
Authorized Official - Phone:773-398-7873
Mailing Address - Street 1:919 N WOLCOTT AVE
Mailing Address - Street 2:#201
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-7229
Mailing Address - Country:US
Mailing Address - Phone:773-398-7873
Mailing Address - Fax:773-435-6734
Practice Address - Street 1:919 N WOLCOTT AVE
Practice Address - Street 2:#201
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-7229
Practice Address - Country:US
Practice Address - Phone:773-398-7873
Practice Address - Fax:773-435-6734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146005299235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty