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Organization
SPEECH 4 KIDS, P.C.
Active
Organization
SPEECH 4 KIDS, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KYNDA POTTORFF M.S. CCC/SLP (PRESIDENT)
(618) 847-5437
Entity
Organization
Contact information
Practice address
RR 3 BOX 947, COUNTY RD. 950 NORTH, FAIRFIELD, IL 62837-9036
(618) 847-5437
(618) 847-5438
Mailing address
RR 3 BOX 947, COUNTY RD. 950 NORTH, FAIRFIELD, IL 62837-9036
(618) 847-5437
(618) 847-5438
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09632007
BC BS SPEECH 4 KIDS
IL
Enumeration date
10/19/2005
Last updated
08/22/2020
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