Provider Demographics
NPI:1871146357
Name:BRAVE SPEECH AND VOICE THERAPY, LLC
Entity type:Organization
Organization Name:BRAVE SPEECH AND VOICE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:KAMPHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-473-8315
Mailing Address - Street 1:4N211 KAELIN RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-1263
Mailing Address - Country:US
Mailing Address - Phone:630-473-8315
Mailing Address - Fax:
Practice Address - Street 1:4N211 KAELIN RD
Practice Address - Street 2:
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-1263
Practice Address - Country:US
Practice Address - Phone:630-473-8315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty