Healthcare Provider Details

I. General information

NPI: 1407761497
Provider Name (Legal Business Name): GABRIELA KANDORA CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11424 S WESTERN AVE
CHICAGO IL
60643-4120
US

IV. Provider business mailing address

1905 BROPHY AVE
PARK RIDGE IL
60068-5203
US

V. Phone/Fax

Practice location:
  • Phone: 773-701-6456
  • Fax:
Mailing address:
  • Phone: 630-863-8013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146.029268
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: