Provider Demographics
NPI:1427284884
Name:ADVANCEMENT TX LLC
Entity type:Organization
Organization Name:ADVANCEMENT TX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNISE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MSCCC-SLP/L
Authorized Official - Phone:800-430-8150
Mailing Address - Street 1:4710 LINCOLN HWY
Mailing Address - Street 2:SUITE 263
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-2316
Mailing Address - Country:US
Mailing Address - Phone:800-430-8150
Mailing Address - Fax:800-430-8150
Practice Address - Street 1:122 TOWN CENTER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2251
Practice Address - Country:US
Practice Address - Phone:708-748-5700
Practice Address - Fax:800-430-8150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.008715235Z00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========6047101Medicaid