Provider Demographics
NPI:1285081281
Name:EXPRESSIONS PEDIATRIC SPEECH THERAPY, INC
Entity type:Organization
Organization Name:EXPRESSIONS PEDIATRIC SPEECH THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-414-3326
Mailing Address - Street 1:2472 W FOSTER AVE
Mailing Address - Street 2:#211
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-6962
Mailing Address - Country:US
Mailing Address - Phone:773-414-3326
Mailing Address - Fax:773-304-4668
Practice Address - Street 1:2472 W FOSTER AVE
Practice Address - Street 2:#211
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-6962
Practice Address - Country:US
Practice Address - Phone:773-414-3326
Practice Address - Fax:773-304-4668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146008815235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty