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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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