Provider Demographics
NPI:1447249651
Name:SPEECH 4 KIDS, P.C.
Entity type:Organization
Organization Name:SPEECH 4 KIDS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTORFF
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC/SLP
Authorized Official - Phone:618-847-5437
Mailing Address - Street 1:RR 3 BOX 947
Mailing Address - Street 2:COUNTY RD. 950 NORTH
Mailing Address - City:FAIRFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62837-9036
Mailing Address - Country:US
Mailing Address - Phone:618-847-5437
Mailing Address - Fax:618-847-5438
Practice Address - Street 1:RR 3 BOX 947
Practice Address - Street 2:COUNTY RD. 950 NORTH
Practice Address - City:FAIRFIELD
Practice Address - State:IL
Practice Address - Zip Code:62837-9036
Practice Address - Country:US
Practice Address - Phone:618-847-5437
Practice Address - Fax:618-847-5438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09632007OtherBC BS SPEECH 4 KIDS