| NPI | 1043027105 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MACKENZI JO TALLCOTT Owner/Speech Language Pathologist 217-209-1748 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, |
| Enumeration Date | 2024-12-12 |
| Last Update Date | 2024-12-12 |