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General NPI Number Information
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NPI Number | 1639859028
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Entity Type | Individual
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Provider Name | AMANDA GILES VAZQUEZ
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Gender | Female
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Dates
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Enumeration Date | 07/20/2023
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Last Update Date | 07/20/2023
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Provider Practice Location Address
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Address Line | 4057 N FRANCISCO AVE APT 3W
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City | CHICAGO
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State | IL
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Zip | 60618-2645
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Country | US
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Telephone | 787-939-2293
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Fax |
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Provider Business Mailing Address
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Address Line | 4057 N FRANCISCO AVE APT 3W
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City | CHICAGO
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State | IL
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Zip | 60618-2645
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Country | US
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Telephone | 787-930-2293
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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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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 242.007243
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License Number State | IL
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