Provider Demographics
NPI:1427240837
Name:LITTLE KIDS SPEECH THERAPY, INC.
Entity type:Organization
Organization Name:LITTLE KIDS SPEECH THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARCY
Authorized Official - Middle Name:ATIA
Authorized Official - Last Name:RAK
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:618-792-3503
Mailing Address - Street 1:500 COPPER BEND RD
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-5688
Mailing Address - Country:US
Mailing Address - Phone:618-792-3503
Mailing Address - Fax:618-288-9276
Practice Address - Street 1:500 COPPER BEND RD
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-5688
Practice Address - Country:US
Practice Address - Phone:618-792-3503
Practice Address - Fax:618-288-9276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty