Healthcare Provider Details

I. General information

NPI: 1841106283
Provider Name (Legal Business Name): ANA MENA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7735 W 66TH PL
BEDFORD PARK IL
60501-1903
US

IV. Provider business mailing address

5311 S 73RD CT APT 4
SUMMIT ARGO IL
60501-1059
US

V. Phone/Fax

Practice location:
  • Phone: 708-458-7150
  • Fax:
Mailing address:
  • Phone: 708-420-2157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: