Healthcare Provider Details

I. General information

NPI: 1740193507
Provider Name (Legal Business Name): AMATULLAH ABBAS DAHODWALA MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMATULLAH QURESH CASSIM

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6722 FIELDSTONE DR
BURR RIDGE IL
60527-5297
US

IV. Provider business mailing address

6722 FIELDSTONE DR
BURR RIDGE IL
60527-5297
US

V. Phone/Fax

Practice location:
  • Phone: 786-519-0786
  • Fax:
Mailing address:
  • Phone: 786-519-0786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146029229
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: