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Organization
SPEECH & LEARNING CONNECTIONS
Active
Organization
SPEECH & LEARNING CONNECTIONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BASHA ONTIVEROS M.S., CCC-SLP (DIRECTOR/OWNER)
(309) 663-4172
Entity
Organization
Contact information
Practice address
2412 E WASHINGTON ST, 8B, BLOOMINGTON, IL 61704-4497
(309) 663-4172
Mailing address
2412 E WASHINGTON ST, 8B, BLOOMINGTON, IL 61704-4497
(309) 663-4172
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146007682
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5732059
BLUE CROSS BLUE SHIELD IL
IL
Enumeration date
11/07/2007
Last updated
07/25/2008
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