Provider Demographics
NPI:1154784791
Name:SECOND CITY SPEECH, LLC
Entity type:Organization
Organization Name:SECOND CITY SPEECH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:CLAIRE
Authorized Official - Last Name:ARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-225-8349
Mailing Address - Street 1:1520 N DAMEN AVE
Mailing Address - Street 2:SUITE D, OFFICE #4
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-1967
Mailing Address - Country:US
Mailing Address - Phone:317-225-8349
Mailing Address - Fax:
Practice Address - Street 1:4120 W FLETCHER ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-5431
Practice Address - Country:US
Practice Address - Phone:317-225-8349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-31
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146011927235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty