Healthcare Provider Details

I. General information

NPI: 1457972705
Provider Name (Legal Business Name): MICHELLE E ESTAND MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 04/28/2020
Certification Date: 04/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 185TH, TINLEY PARK, IL 60487, SUITE A/B, SUITE A/B SUITE A/B
TINLEY PARK IL
60487
US

IV. Provider business mailing address

9137 S SPAULDING AVE
EVERGREEN PARK IL
60805-1551
US

V. Phone/Fax

Practice location:
  • Phone: 708-580-0440
  • Fax:
Mailing address:
  • Phone: 708-636-7263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: