Healthcare Provider Details

I. General information

NPI: 1972412393
Provider Name (Legal Business Name): VALESTA LUDLOW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 WILLOW CT
MATTESON IL
60443-1168
US

IV. Provider business mailing address

118 WILLOW CT
MATTESON IL
60443-1168
US

V. Phone/Fax

Practice location:
  • Phone: 708-362-3581
  • Fax: 708-869-9061
Mailing address:
  • Phone: 708-362-3581
  • Fax: 708-869-9061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberJ6G6L6Q4
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: