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General NPI Number Information
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NPI Number | 1265704829
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Entity Type | Individual
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Provider Name | PATRICIA MARY MRAZ CCC-SLP/L
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Gender | Female
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Dates
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Enumeration Date | 01/29/2012
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Last Update Date | 01/29/2012
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Provider Practice Location Address
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Address Line | 3700 W 103RD ST LUDDEN CLINIC
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City | CHICAGO
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State | IL
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Zip | 60655-3105
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Country | US
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Telephone | 177-329-8357
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Fax |
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Provider Business Mailing Address
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Address Line | 10654 GIGI DR
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City | ORLAND PARK
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State | IL
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Zip | 60462-2879
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Country | US
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Telephone | 708-280-8933
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 146007880
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License Number State | IL
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