Healthcare Provider Details

I. General information

NPI: 1083547004
Provider Name (Legal Business Name): VALERIA GRALAK JR.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VALERIA CARRILLO

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1447 W MONTROSE AVE
CHICAGO IL
60613-1348
US

IV. Provider business mailing address

1447 W MONTROSE AVE
CHICAGO IL
60613-1348
US

V. Phone/Fax

Practice location:
  • Phone: 312-624-8750
  • Fax:
Mailing address:
  • Phone: 312-624-8750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: