Imagination Therapy, LLC

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

146.011712 Issued in IL

Legal business name

IMAGINATION THERAPY, LLC

Practice address

805 Lake St # 235
Oak Park, IL 60301-1301

Phone

(708) 305-2176

NPI assigned

Jan 4, 2018

Last updated

Mar 17, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Miss Katherine M Wilkie, MS, CCC-SLPNPI 1154756443

Title

Owner/Speech Pathologist

Phone

(708) 305-2176

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Katherine M Wilkie, MS, CCC-SLP

  • Speech-Language Pathologist
  • Oak Park, IL
  • NPI 1154756443
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1515024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1235646894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 LAKE ST # 235",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603011301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 LAKE ST # 235",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603011301",
            "telephone_number": "708-305-2176"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "640 Harrison St Apt 2S",
            "address_purpose": "LOCATION",
            "city": "Oak Park",
            "state": "IL",
            "postal_code": "603041349",
            "country_code": "US",
            "telephone_number": "708-305-2176",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "743 S East Ave",
            "address_purpose": "LOCATION",
            "city": "Oak Park",
            "state": "IL",
            "postal_code": "603041325",
            "country_code": "US",
            "telephone_number": "708-305-2176",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "IMAGINATION THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-04",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "WILKIE",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER/SPEECH PATHOLOGIST",
        "authorized_official_telephone_number": "708-305-2176",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "MS, CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146.011712",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1154756443",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Oak Park, IL
• Providers in Oak Park, IL by specialty
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.