Organization
JENNIFER M MAUCK DBA BLOOM INTO SPEECH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KARIN RICHTER (BILLING SERVICE)
(847) 769-5316
Entity
Organization
Contact information
Practice address
164 N MYRTLE AVE, ELMHURST, IL 60126-2625
(773) 771-2386
(630) 279-0357
Mailing address
164 N MYRTLE AVE, ELMHURST, IL 60126-2625
(773) 771-2386
(630) 279-0357
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146006465
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
351701468
—
IL
Enumeration date
07/13/2009
Last updated
07/13/2009
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