Organization
SI SPEECH PATHOLOGY SERVICES
Active
Other names
SI Speech Pathology Services
Organization subpart
No
Provider details
NPI number
Authorized official
SAMANRHA INCAPRERA (SUPERVISOR)
(618) 599-4340
Entity
Organization
Contact information
Practice address
1764 COUNTY ROAD 1850 N, CISNE, IL 62823-7774
(618) 599-4340
Mailing address
1764 COUNTY ROAD 1850 N, CISNE, IL 62823-7774
(618) 599-4340
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578028882
—
IL
Enumeration date
01/10/2020
Last updated
01/10/2020
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