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General NPI Number Information
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NPI Number | 1346133121
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Entity Type | Individual
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Provider Name | MARA LYSSETT CONTRERAS
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Gender | Female
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Dates
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Enumeration Date | 05/31/2025
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Last Update Date | 05/31/2025
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Provider Practice Location Address
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Address Line | 3810 W 82ND ST
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City | CHICAGO
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State | IL
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Zip | 60652-2436
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Country | US
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Telephone | 773-870-9697
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Fax |
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Provider Business Mailing Address
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Address Line | 6912 CERMAK RD
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City | BERWYN
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State | IL
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Zip | 60402-2244
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Country | US
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Telephone | 708-813-9062
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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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