Provider Demographics
NPI:1376663484
Name:GOLD STAR SPEECH THERAPY, P.C.
Entity type:Organization
Organization Name:GOLD STAR SPEECH THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:L
Authorized Official - Last Name:STREICHER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:630-605-9391
Mailing Address - Street 1:236 BERKSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60554-9479
Mailing Address - Country:US
Mailing Address - Phone:630-605-9391
Mailing Address - Fax:630-466-3735
Practice Address - Street 1:236 BERKSHIRE LN
Practice Address - Street 2:
Practice Address - City:SUGAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:60554-9479
Practice Address - Country:US
Practice Address - Phone:630-605-9391
Practice Address - Fax:630-466-3735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4532028OtherBCBS PROVIDER NUMBER