Provider Demographics
NPI:1760860589
Name:TINY VOICE THERAPY SERVICES
Entity type:Organization
Organization Name:TINY VOICE THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-508-8327
Mailing Address - Street 1:601 E GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:WATERMAN
Mailing Address - State:IL
Mailing Address - Zip Code:60556-9861
Mailing Address - Country:US
Mailing Address - Phone:815-508-8327
Mailing Address - Fax:815-264-3039
Practice Address - Street 1:601 E GARFIELD ST
Practice Address - Street 2:
Practice Address - City:WATERMAN
Practice Address - State:IL
Practice Address - Zip Code:60556-9861
Practice Address - Country:US
Practice Address - Phone:815-508-8327
Practice Address - Fax:815-264-3039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146011731305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service