NPI | 1053768523 |
---|---|
Former Legal Business Name | SHINE INTERACTIONS LLC |
Entity Type | Organization |
Authorized Contact | TERRY KAY DAVEY Speech Pathologist 618-541-2040 |
Organization Subpart ? | No |
Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: IL 146.007858) |
Additional Taxonomies | 252Y00000X Early Intervention Provider Agency (Licence: IL 146.007858) |
Enumeration Date | 2016-05-15 |
Last Update Date | 2018-01-10 |