| NPI | 1457789786 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA JOHNSON Owner 618-334-4550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: IL 146.011341) |
| Enumeration Date | 2013-10-23 |
| Last Update Date | 2015-02-27 |