| NPI | 1487679676 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA J TRACY Owner 618-656-7157 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: IL 146003318) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2020-08-22 |