Organization
GROW PEDIATRIC THERAPY CORNER, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAJ'ZA MITCHELL (OWNER, SPEECH-LANGUAGE PATHOLOGIST)
(708) 362-9839
Entity
Organization
Contact information
Practice address
920 S SPRING ST, SPRINGFIELD, IL 62704-2725
(708) 362-9839
Mailing address
920 S SPRING ST, SPRINGFIELD, IL 62704-2725
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
106E00000X
Assistant Behavior Analyst
—
—
106S00000X
Behavior Technician
—
—
222Q00000X
Developmental Therapist
—
—
224Z00000X
Occupational Therapy Assistant
—
—
2251P0200X
Pediatric Physical Therapist
—
—
225200000X
Physical Therapy Assistant
—
—
225A00000X
Music Therapist
—
—
225X00000X
Occupational Therapist
—
—
225XF0002X
Feeding, Eating & Swallowing Occupational Therapist
—
—
231H00000X
Audiologist
—
—
2355S0801X
Speech-Language Assistant
—
—
235Z00000X
Speech-Language Pathologist
Primary
—
—
261QA3000X
Augmentative Communication Clinic/Center
—
—
Other
Enumeration date
11/27/2023
Last updated
11/27/2023
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