Provider Demographics
NPI:1104290279
Name:NEWSOME SPEECH AND LANGUAGE THERAPY P. C.
Entity type:Organization
Organization Name:NEWSOME SPEECH AND LANGUAGE THERAPY P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTZOG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-889-8035
Mailing Address - Street 1:6351 W MONTROSE AVE
Mailing Address - Street 2:#304
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-1563
Mailing Address - Country:US
Mailing Address - Phone:773-889-8035
Mailing Address - Fax:773-637-1976
Practice Address - Street 1:6351 W MONTROSE AVE
Practice Address - Street 2:#304
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-1563
Practice Address - Country:US
Practice Address - Phone:773-889-8035
Practice Address - Fax:773-637-1976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-30
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty