Healthcare Provider Details

I. General information

NPI: 1700795846
Provider Name (Legal Business Name): REAGAN ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2S500 GRAY AVE
LOMBARD IL
60148-5194
US

IV. Provider business mailing address

18W724 20TH PL
LOMBARD IL
60148-5008
US

V. Phone/Fax

Practice location:
  • Phone: 630-827-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: