Provider Demographics
NPI:1194052191
Name:THERAPEUTIC VALUES PROF CORP
Entity type:Organization
Organization Name:THERAPEUTIC VALUES PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:MHS, CCC, SLP/L
Authorized Official - Phone:708-527-1595
Mailing Address - Street 1:16036 AVALON AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-1844
Mailing Address - Country:US
Mailing Address - Phone:708-527-1595
Mailing Address - Fax:
Practice Address - Street 1:16036 AVALON AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-1844
Practice Address - Country:US
Practice Address - Phone:708-527-1595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-11
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146007298251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health