Healthcare Provider Details

I. General information

NPI: 1902389737
Provider Name (Legal Business Name): VANESSA EDISA SAENZ SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

787 KANE ST
AURORA IL
60505-3622
US

IV. Provider business mailing address

787 KANE ST
AURORA IL
60505-3622
US

V. Phone/Fax

Practice location:
  • Phone: 630-456-6459
  • Fax:
Mailing address:
  • Phone: 630-456-6459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number217.000398
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: