Healthcare Provider Details

I. General information

NPI: 1619892064
Provider Name (Legal Business Name): MARIA PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 LEAWOOD DR
JOLIET IL
60431-9010
US

IV. Provider business mailing address

1020 LEAWOOD DR
JOLIET IL
60431-9010
US

V. Phone/Fax

Practice location:
  • Phone: 773-744-1470
  • Fax:
Mailing address:
  • Phone: 773-744-1470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: