Provider Demographics
NPI:1336616986
Name:ADVANCED THERAPY & WELLNESS CENTER, P.C.
Entity Type:Organization
Organization Name:ADVANCED THERAPY & WELLNESS CENTER, P.C.
Other - Org Name:ADVANCED SPEECH THERAPY, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SLP/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:STOCH
Authorized Official - Suffix:
Authorized Official - Credentials:MHS, CCC-SLP
Authorized Official - Phone:815-782-4196
Mailing Address - Street 1:16009 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60403-0500
Mailing Address - Country:US
Mailing Address - Phone:815-782-4196
Mailing Address - Fax:
Practice Address - Street 1:16009 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60403-0500
Practice Address - Country:US
Practice Address - Phone:815-782-4196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-31
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty