Organization
MARIGOLD PEDIATRIC THERAPY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELLEN HENNING (SLP)
(815) 325-9513
Entity
Organization
Contact information
Practice address
121 POMEROY AVE, CRYSTAL LAKE, IL 60014-5922
(815) 325-9513
Mailing address
121 POMEROY AVE, CRYSTAL LAKE, IL 60014-5922
Taxonomy
Speciality
Code
Description
License number
State
261QH0700X
Hearing and Speech Clinic/Center
Primary
—
—
Other
Enumeration date
05/15/2019
Last updated
10/31/2019
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