Provider Demographics
NPI:1992713705
Name:VILLAGE THERAPY SERVICES, INC.
Entity type:Organization
Organization Name:VILLAGE THERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WACHHOLDER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:847-697-6473
Mailing Address - Street 1:100 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:GILBERTS
Mailing Address - State:IL
Mailing Address - Zip Code:60136-4037
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 SUMMIT DR
Practice Address - Street 2:
Practice Address - City:GILBERTS
Practice Address - State:IL
Practice Address - Zip Code:60136-4037
Practice Address - Country:US
Practice Address - Phone:847-697-6473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0004532306OtherBLUE CROSS BLUE SHIELD