Healthcare Provider Details

I. General information

NPI: 1699682518
Provider Name (Legal Business Name): KELIN MENDOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8101 OGDEN AVE
LYONS IL
60534-1700
US

IV. Provider business mailing address

8848 MEADE AVE
OAK LAWN IL
60453-1143
US

V. Phone/Fax

Practice location:
  • Phone: 708-783-4100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146019011
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: