Healthcare Provider Details

I. General information

NPI: 1023520855
Provider Name (Legal Business Name): PRISCILLA ESCATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2017
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 N 8TH ST
ROCHELLE IL
61068-1460
US

IV. Provider business mailing address

1010 CHICAGO ST
MENDOTA IL
61342-1508
US

V. Phone/Fax

Practice location:
  • Phone: 815-562-6363
  • Fax:
Mailing address:
  • Phone: 815-503-4423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146.014274
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: