Healthcare Provider Details

I. General information

NPI: 1760641468
Provider Name (Legal Business Name): MEREDITH NICOLE GALOS M.S., SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 SHORELINE DR
AURORA IL
60504-6192
US

IV. Provider business mailing address

909 HILLVIEW DR
LEMONT IL
60439-4333
US

V. Phone/Fax

Practice location:
  • Phone: 630-375-5900
  • Fax:
Mailing address:
  • Phone: 630-207-6958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number242000592
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146009433
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: