Provider Demographics
NPI:1982894796
Name:CHATTERBOX PEDIATRIC THERAPY INC
Entity Type:Organization
Organization Name:CHATTERBOX PEDIATRIC THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:GLYNN
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:708-601-2696
Mailing Address - Street 1:25439 BOWER CT
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-2579
Mailing Address - Country:US
Mailing Address - Phone:708-601-2696
Mailing Address - Fax:815-267-8446
Practice Address - Street 1:25439 BOWER CT
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-2579
Practice Address - Country:US
Practice Address - Phone:708-601-2696
Practice Address - Fax:815-267-8446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1477691707OtherNPI TYPE 1
IL12084979OtherASHA