Healthcare Provider Details

I. General information

NPI: 1063926939
Provider Name (Legal Business Name): ANASTASIA MOCK ANDERSON AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2017
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16001 108TH AVE STE A2
ORLAND PARK IL
60467-8789
US

IV. Provider business mailing address

16001 108TH AVE STE A2
ORLAND PARK IL
60467-8789
US

V. Phone/Fax

Practice location:
  • Phone: 708-460-0007
  • Fax: 708-460-0005
Mailing address:
  • Phone: 708-460-0007
  • Fax: 708-460-0005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147001738
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: