Healthcare Provider Details

I. General information

NPI: 1043136898
Provider Name (Legal Business Name): ISABELLA JUAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5811 S MULLIGAN AVE
CHICAGO IL
60638-3430
US

IV. Provider business mailing address

5811 S MULLIGAN AVE
CHICAGO IL
60638-3430
US

V. Phone/Fax

Practice location:
  • Phone: 773-512-4349
  • Fax:
Mailing address:
  • Phone: 773-512-4349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146.018869
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: