Provider Demographics
NPI:1881145563
Name:TINY VOICE THERAPY SERVICES LLC
Entity type:Organization
Organization Name:TINY VOICE THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC SLP
Authorized Official - Phone:815-508-8327
Mailing Address - Street 1:601 E GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:WATERMAN
Mailing Address - State:IL
Mailing Address - Zip Code:60556-9861
Mailing Address - Country:US
Mailing Address - Phone:815-508-8327
Mailing Address - Fax:815-264-3039
Practice Address - Street 1:601 E GARFIELD ST
Practice Address - Street 2:
Practice Address - City:WATERMAN
Practice Address - State:IL
Practice Address - Zip Code:60556-9861
Practice Address - Country:US
Practice Address - Phone:815-508-8327
Practice Address - Fax:815-264-3039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146011731235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty