Provider Demographics
NPI:1316062797
Name:SPEECH & LANGUAGE REHABILITATION SERVICE LTD
Entity type:Organization
Organization Name:SPEECH & LANGUAGE REHABILITATION SERVICE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANILA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCASEY
Authorized Official - Suffix:
Authorized Official - Credentials:SLP/L
Authorized Official - Phone:309-689-9920
Mailing Address - Street 1:2001 W WILLOW KNOLLS DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-1290
Mailing Address - Country:US
Mailing Address - Phone:309-689-9920
Mailing Address - Fax:309-689-9923
Practice Address - Street 1:2001 W WILLOW KNOLLS DR
Practice Address - Street 2:SUITE 106
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-1290
Practice Address - Country:US
Practice Address - Phone:309-689-9920
Practice Address - Fax:309-689-9923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL07215148OtherBLUE CROSS BLUE SHIELD