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Organization
BUILDING BLOCK PEDIATRIC THERAPIES OF ILLINOIS LLC
Active
Organization
BUILDING BLOCK PEDIATRIC THERAPIES OF ILLINOIS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LAURIE FOWLER (MANAGER)
(847) 254-1040
Entity
Organization
Contact information
Practice address
1107 W. PARK KAVE., LIBERTYVILLE, IL 60048
(847) 254-1040
Mailing address
1107 W PARK AVE, LIBERTYVILLE, IL 60048-2552
(847) 254-1040
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
056010239
IL
235Z00000X
Speech-Language Pathologist
Primary
146007078
IL
235Z00000X
Speech-Language Pathologist
1460099190
IL
Other
Enumeration date
08/18/2014
Last updated
01/05/2015
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