Healthcare Provider Details

I. General information

NPI: 1659884682
Provider Name (Legal Business Name): COMTEC CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 S GROVE AVE
OAK PARK IL
60304-1124
US

IV. Provider business mailing address

817 S GROVE AVE
OAK PARK IL
60304-1124
US

V. Phone/Fax

Practice location:
  • Phone: 708-297-0259
  • Fax:
Mailing address:
  • Phone: 708-297-0259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. DANA YALA
Title or Position: SPEECH AND LANGUAGE PATHOLOGIST
Credential: CCC-SLP/L
Phone: 708-297-0259