Organization
IMAGINATION THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS KATHERINE M WILKIE MS, CCC-SLP (OWNER/SPEECH PATHOLOGIST)
(708) 305-2176
Entity
Organization
Contact information
Practice address
805 LAKE ST # 235, OAK PARK, IL 60301-1301
(708) 305-2176
Mailing address
805 LAKE ST # 235, OAK PARK, IL 60301-1301
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146.011712
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1154756443
—
IL
Enumeration date
01/04/2018
Last updated
03/17/2018
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