Healthcare Provider Details

I. General information

NPI: 1982535571
Provider Name (Legal Business Name): DAISY A COVARRUBIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DAISY A PORZELT

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 E LINCOLN ST STE 209
NORMAL IL
61761-6406
US

IV. Provider business mailing address

813 REINTHALER RD
BLOOMINGTON IL
61701-5814
US

V. Phone/Fax

Practice location:
  • Phone: 309-431-2151
  • Fax:
Mailing address:
  • Phone: 309-533-8777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: