Provider Demographics
NPI:1982313649
Name:DYNAMIC SWALLOW AND SPEECH THERAPEUTICS
Entity Type:Organization
Organization Name:DYNAMIC SWALLOW AND SPEECH THERAPEUTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:T
Authorized Official - Last Name:FERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:310-766-9812
Mailing Address - Street 1:5100 N RAVENSWOOD AVE STE 216A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1752
Mailing Address - Country:US
Mailing Address - Phone:310-766-9812
Mailing Address - Fax:
Practice Address - Street 1:5100 N RAVENSWOOD AVE STE 216A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-1752
Practice Address - Country:US
Practice Address - Phone:310-766-9812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-21
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty