Provider Demographics
NPI:1952725913
Name:CHICAGO SPEECH THERAPY
Entity Type:Organization
Organization Name:CHICAGO SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CCC-SLP
Authorized Official - Prefix:
Authorized Official - First Name:KARI
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:MACKAY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:708-227-2583
Mailing Address - Street 1:447 W SURF ST
Mailing Address - Street 2:3W
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6164
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:447 W SURF ST
Practice Address - Street 2:3W
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6164
Practice Address - Country:US
Practice Address - Phone:708-227-2583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.011671235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty