Healthcare Provider Details

I. General information

NPI: 1487227419
Provider Name (Legal Business Name): ARACELI MENDOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 KENT ST
ROCKFORD IL
61102-2748
US

IV. Provider business mailing address

1221 KENT ST
ROCKFORD IL
61102-2748
US

V. Phone/Fax

Practice location:
  • Phone: 779-770-8933
  • Fax:
Mailing address:
  • Phone: 779-770-8933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146.018786
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number217.000425
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number242.008111
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: