Healthcare Provider Details

I. General information

NPI: 1770139834
Provider Name (Legal Business Name): LAURA JOANA AYALA SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 S WASHINGTON ST
NAPERVILLE IL
60565-1368
US

IV. Provider business mailing address

440 N ANNA LN
ROMEOVILLE IL
60446-5283
US

V. Phone/Fax

Practice location:
  • Phone: 815-469-1500
  • Fax:
Mailing address:
  • Phone: 815-341-7802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number217000386
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number242007468
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number242.007468
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: