NPIMap

Organization Active NPI

Self Talk Therapy Services PC

  • Speech-Language Pathologist
  • Crystal Lake, IL
National Provider Identifier
1508310459
Registry record updated Sep 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Legal business name
SELF TALK THERAPY SERVICES PC
Practice address
8600 US Highway 14
Crystal Lake, IL 60012-2706
Phone
(815) 403-0485
Fax
(815) 277-1242
NPI assigned
Aug 9, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2023

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

Authorized official

Name
Mrs. Ashli J Self, M.A. CCC-SLPNPI 1174989453
Title
President/Speech-Language Path.
Phone
(815) 403-0485

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X Primary

Addresses

Primary practice location

8600 US Highway 14
Crystal Lake, IL 60012-2706

Mailing address

5704 Wonder Woods Dr
Wonder Lake, IL 60097-9114

Other identifiers 1

IdentifierTypeStateIssuer
13683650OtherILCAQH

National Provider Directory

National Provider Directory

Locations

8600 US Highway 14
Ste 108
Crystal Lake, IL 60012
Phone (630) 379-7775

1575 W Lake Shore Dr
Woodstock, IL 60098
Phone (262) 214-6425

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1470700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694736000000",
    "number": "1508310459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5704 WONDER WOODS DR",
            "city": "WONDER LAKE",
            "state": "IL",
            "postal_code": "600979114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8600 US HIGHWAY 14",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600122706",
            "telephone_number": "815-403-0485",
            "fax_number": "815-277-1242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF TALK THERAPY SERVICES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-09",
        "last_updated": "2023-09-15",
        "certification_date": "2023-09-15",
        "status": "A",
        "authorized_official_last_name": "SELF",
        "authorized_official_first_name": "ASHLI",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT/SPEECH-LANGUAGE PATH.",
        "authorized_official_telephone_number": "815-403-0485",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.A. CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "13683650",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crystal Lake, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2023; 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.