Basic Information
| Provider Information | |||||||||
| NPI: | 1699084541 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SPEECH PATH LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31480 N US HIGHWAY 45 | ||||||||
| Address2: | |||||||||
| City: | LIBERTYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600489444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476802715 | ||||||||
| FaxNumber: | 8476803832 | ||||||||
| Practice Location | |||||||||
| Address1: | 31480 N US HIGHWAY 45 | ||||||||
| Address2: | |||||||||
| City: | LIBERTYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600489444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476802715 | ||||||||
| FaxNumber: | 8476803832 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2010 | ||||||||
| LastUpdateDate: | 09/27/2010 | ||||||||
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| AuthorizedOfficialLastName: | CARUTH | ||||||||
| AuthorizedOfficialFirstName: | CHET | ||||||||
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| AuthorizedOfficialTitleorPosition: | LICENSED SPEECH-PATHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 8476802715 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LSP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 146006125 | IL | Y | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.