Healthcare Provider Details

I. General information

NPI: 1871162214
Provider Name (Legal Business Name): MELISSA MENENDEZ M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1739 N ELSTON AVE
CHICAGO IL
60642-1544
US

IV. Provider business mailing address

1125 W VAN BUREN ST APT 501
CHICAGO IL
60607-0048
US

V. Phone/Fax

Practice location:
  • Phone: 773-687-9241
  • Fax:
Mailing address:
  • Phone: 773-707-3916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146.013739
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: