Provider Demographics
NPI:1699084541
Name:SPEECH PATH LTD
Entity type:Organization
Organization Name:SPEECH PATH LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED SPEECH-PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CHET
Authorized Official - Middle Name:
Authorized Official - Last Name:CARUTH
Authorized Official - Suffix:
Authorized Official - Credentials:LSP
Authorized Official - Phone:847-680-2715
Mailing Address - Street 1:31480 N US HIGHWAY 45
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-9444
Mailing Address - Country:US
Mailing Address - Phone:847-680-2715
Mailing Address - Fax:847-680-3832
Practice Address - Street 1:31480 N US HIGHWAY 45
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-9444
Practice Address - Country:US
Practice Address - Phone:847-680-2715
Practice Address - Fax:847-680-3832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146006125235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty