Provider Demographics
NPI:1356526362
Name:TINY VOICES THERAPY PC
Entity type:Organization
Organization Name:TINY VOICES THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:BOURISAW
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC/SLP/L
Authorized Official - Phone:636-565-4112
Mailing Address - Street 1:2627 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236-2657
Mailing Address - Country:US
Mailing Address - Phone:636-565-4112
Mailing Address - Fax:636-590-9969
Practice Address - Street 1:2627 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:IL
Practice Address - Zip Code:62236-2657
Practice Address - Country:US
Practice Address - Phone:636-565-4112
Practice Address - Fax:636-590-9969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
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