MEDICARE: MRS. IVONNE MENDOZA VIRGEN SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1497287908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. IVONNE MENDOZA VIRGEN SLP

Provider Business Mailing Address
First Line	:	2100 GREEN BAY RD
Second Line	:
City	:	NORTH CHICAGO
State	:	IL
Zip	:	60064-2838
Country	:	US
Telephone Number	:	630-297-7588
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 GREEN BAY RD
Second Line	:
City	:	NORTH CHICAGO
State	:	IL
Zip	:	60064-2838
Country	:	US
Telephone Number	:	630-297-7588
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2017
Last Update Date	:	10/05/2022

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Directions to “ MRS. IVONNE MENDOZA VIRGEN SLP” Practice Location

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