NPI | 1255511283 |
---|---|
Entity Type | Organization |
Authorized Contact | BASHA ONTIVEROS Director/Owner 309-663-4172 |
Organization Subpart ? | No |
Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: IL 146007682) |
Enumeration Date | 2007-11-07 |
Last Update Date | 2008-07-25 |