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General NPI Number Information
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NPI Number | 1629712864
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Entity Type | Individual
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Provider Name | MITRA YARANDI MS-CCC-SLP/L
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Gender | Female
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Dates
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Enumeration Date | 04/25/2022
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Last Update Date | 04/25/2022
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Provider Practice Location Address
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Address Line | 431 REMINGTON BLVD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-4918
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Country | US
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Telephone | 630-759-1112
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Fax |
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Provider Business Mailing Address
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Address Line | 2807 CENTRE CIR
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-1030
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Country | US
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Telephone | 630-717-8060
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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 | 146.008439
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License Number State | IL
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