Provider Demographics
NPI:1265556534
Name:CENTRAL SPEECH AND LANGUAGE CLINIC, INC.
Entity type:Organization
Organization Name:CENTRAL SPEECH AND LANGUAGE CLINIC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:847-821-1237
Mailing Address - Street 1:4160 IL ROUTE 83
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LONG GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60047-5083
Mailing Address - Country:US
Mailing Address - Phone:847-821-1237
Mailing Address - Fax:847-276-2743
Practice Address - Street 1:4160 IL ROUTE 83
Practice Address - Street 2:SUITE 101
Practice Address - City:LONG GROVE
Practice Address - State:IL
Practice Address - Zip Code:60047-5083
Practice Address - Country:US
Practice Address - Phone:847-821-1237
Practice Address - Fax:847-276-2743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty