Organization
EVERGREEN PEDIATRIC THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEAH SONGER M.A., CCC-SLP (OWNER/SPEECH-LANGUAGE PATHOLOGIST)
(217) 549-4507
Entity
Organization
Contact information
Practice address
1803 N CALIFORNIA AVE, CHICAGO, IL 60647-5105
(217) 549-4507
Mailing address
3500 W EVERGREEN AVE, CHICAGO, IL 60651
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
146.0009085
IL
Other
Enumeration date
01/08/2018
Last updated
01/08/2018
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