Organization
BUILDING BLOCKS PEDIATRIC THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLIE R. ALLEN MS,CCC-SLP (OWNER/SPEECH LANGUAGE PATHOLOGIST)
(618) 401-2648
Entity
Organization
Contact information
Practice address
8643 FRUIT RD, EDWARDSVILLE, IL 62025-6521
(618) 401-2648
Mailing address
8643 FRUIT RD, EDWARDSVILLE, IL 62025-6521
(618) 401-2648
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06027704
BLUS CROSS BLUE SHIELD
IL
Enumeration date
07/16/2006
Last updated
08/22/2020
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