Provider Demographics
NPI:1285993840
Name:UNITED SPEECH DESIGN THERAPY PROFESSIONALS, LLC
Entity type:Organization
Organization Name:UNITED SPEECH DESIGN THERAPY PROFESSIONALS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/SPEECH THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:L
Authorized Official - Last Name:CORDINA
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:858-405-9050
Mailing Address - Street 1:37 TWEED RD
Mailing Address - Street 2:
Mailing Address - City:FOX LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60020-1626
Mailing Address - Country:US
Mailing Address - Phone:858-405-9050
Mailing Address - Fax:
Practice Address - Street 1:37 TWEED RD
Practice Address - Street 2:
Practice Address - City:FOX LAKE
Practice Address - State:IL
Practice Address - Zip Code:60020-1626
Practice Address - Country:US
Practice Address - Phone:858-405-9050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146004767261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech