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General NPI Number Information
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NPI Number | 1275049520
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Entity Type | Individual
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Provider Name | LAURA GALLARDO
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Gender | Female
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Dates
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Enumeration Date | 12/22/2017
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Last Update Date | 12/22/2017
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Provider Practice Location Address
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Address Line | 555 W COOK ST
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City | MANTENO
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State | IL
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Zip | 60950-3720
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Country | US
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Telephone | 815-928-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 681 DIVERSATECH DR N
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City | MANTENO
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State | IL
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Zip | 60950-3554
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Country | US
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Telephone | 815-954-5602
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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 |
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License Number State |
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