Healthcare Provider Details

I. General information

NPI: 1063851376
Provider Name (Legal Business Name): MARIZA ESCALANTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5427 S MILLARD AVE
CHICAGO IL
60632-3244
US

IV. Provider business mailing address

5427 S MILLARD AVE
CHICAGO IL
60632-3244
US

V. Phone/Fax

Practice location:
  • Phone: 773-701-1179
  • Fax:
Mailing address:
  • Phone: 773-701-1179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: