| NPI | 1275693756 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER SHANE JOHNSON Speech Language Pathologist 773-327-2880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: IL 146-006665) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2020-08-22 |