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Organization
SPEECH SUITE 815
Active
Organization
SPEECH SUITE 815
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NICOLE LUCIA GEDRAITIS MHS, CCC-SLP/L (SPEECH AND LANGUAGE PATHOLOGIST)
(630) 229-7890
Entity
Organization
Contact information
Practice address
838 1ST ST, LA SALLE, IL 61301-2508
(815) 200-8830
(815) 714-6202
Mailing address
115 MARY SENICA CT, LA SALLE, IL 61301-9658
(630) 229-7890
(815) 714-6202
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1902034127
PRIVATE INSURANCE
IL
Enumeration date
10/15/2018
Last updated
10/15/2018
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