Provider Demographics
NPI:1992949523
Name:COMPREHENSIVE PSYCHOLOGICAL AND SPEECH SERVICES, LLC
Entity type:Organization
Organization Name:COMPREHENSIVE PSYCHOLOGICAL AND SPEECH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD - SPEECH THER
Authorized Official - Phone:630-852-7336
Mailing Address - Street 1:707 RIDGEVIEW ST
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-3930
Mailing Address - Country:US
Mailing Address - Phone:630-852-7336
Mailing Address - Fax:630-852-8177
Practice Address - Street 1:1047 S YORK RD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5121
Practice Address - Country:US
Practice Address - Phone:630-852-7336
Practice Address - Fax:630-852-8177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005206103TC0700X
IL146001511235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04922024OtherBLUE CROSS BLUE SHIELD IL
IL108488561001Medicaid
IL02222567OtherBLUE CROSS BLUE SHIELD IL
IL02222567OtherBLUE CROSS BLUE SHIELD IL