Provider Demographics
NPI:1710870571
Name:PATH TO SPEECH PLLC
Entity type:Organization
Organization Name:PATH TO SPEECH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:M
Authorized Official - Last Name:VAN BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:MHS- CCC-SLP
Authorized Official - Phone:847-350-8846
Mailing Address - Street 1:812 ANDOVER CT
Mailing Address - Street 2:
Mailing Address - City:PROSPECT HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60070-1169
Mailing Address - Country:US
Mailing Address - Phone:847-350-8846
Mailing Address - Fax:
Practice Address - Street 1:812 ANDOVER CT
Practice Address - Street 2:
Practice Address - City:PROSPECT HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60070-1169
Practice Address - Country:US
Practice Address - Phone:847-350-8846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty