Healthcare Provider Details

I. General information

NPI: 1841403425
Provider Name (Legal Business Name): LAURA ANNE VALAITIS M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2422 W. MAIN STREET SUITE 3A
ST. CHARLES IL
60175
US

IV. Provider business mailing address

544 S. LIBERTY
ELGIN IL
60120-7941
US

V. Phone/Fax

Practice location:
  • Phone: 630-513-5012
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: