Provider Demographics
NPI:1861752438
Name:SPEECH BREAKTHROUGHS PC
Entity type:Organization
Organization Name:SPEECH BREAKTHROUGHS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:LEQUANA
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-407-6655
Mailing Address - Street 1:1157 E 61ST ST
Mailing Address - Street 2:APT # 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-2740
Mailing Address - Country:US
Mailing Address - Phone:773-407-6655
Mailing Address - Fax:
Practice Address - Street 1:1157 E 61ST ST
Practice Address - Street 2:APT # 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-2740
Practice Address - Country:US
Practice Address - Phone:773-407-6655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146008743252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency