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General NPI Number Information
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NPI Number | 1508717836
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Entity Type | Individual
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Provider Name | MRS. TALIA SARAI FONTANETTA
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Gender | Female
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Dates
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Enumeration Date | 02/04/2026
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Last Update Date | 02/04/2026
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Provider Practice Location Address
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Address Line | 701 GLENWOOD AVE
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City | JOLIET
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State | IL
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Zip | 60435-7775
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Country | US
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Telephone | 815-723-0394
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Fax |
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Provider Business Mailing Address
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Address Line | 6250 W NORTH AVE # 2
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City | CHICAGO
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State | IL
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Zip | 60639-3861
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Country | US
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Telephone |
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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 | 146018016
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License Number State | IL
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