| NPI | 1164128104 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY ASHBY Speech Language Pathologist 217-621-3458 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, |
| Enumeration Date | 2023-02-01 |
| Last Update Date | 2023-04-20 |