| 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 |