Healthcare Provider Details

I. General information

NPI: 1023996659
Provider Name (Legal Business Name): JOY JULIE ANNE BUETA MHS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5110 W 24TH ST
CICERO IL
60804-2948
US

IV. Provider business mailing address

10837 S KOMENSKY AVE
OAK LAWN IL
60453-5369
US

V. Phone/Fax

Practice location:
  • Phone: 708-863-4856
  • Fax:
Mailing address:
  • Phone: 909-434-4156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146016359
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: