Healthcare Provider Details

I. General information

NPI: 1083341382
Provider Name (Legal Business Name): LAURA E RIOS MALDONADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA ELIZABETH RIOS MALDONADO

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 N ADDISON AVE
ELMHURST IL
60126-2809
US

IV. Provider business mailing address

104 FAIRFIELD WAY
BLOOMINGDALE IL
60108-1538
US

V. Phone/Fax

Practice location:
  • Phone: 866-815-6592
  • Fax:
Mailing address:
  • Phone: 708-288-6317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146018831
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: