Provider Demographics
NPI:1386082980
Name:ADR THERAPY INC
Entity type:Organization
Organization Name:ADR THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RODIEK
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:773-899-1278
Mailing Address - Street 1:4157 N KENMORE AVE
Mailing Address - Street 2:#3S
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-6417
Mailing Address - Country:US
Mailing Address - Phone:773-484-3144
Mailing Address - Fax:773-634-8468
Practice Address - Street 1:4157 N KENMORE AVE
Practice Address - Street 2:#3S
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-6417
Practice Address - Country:US
Practice Address - Phone:773-484-3144
Practice Address - Fax:773-634-8468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.010208235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty