MEDICARE: GUADALUPE AVILA M.S. CCC-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	146.015745	IL

General Provider Information

NPI Number	:	1801470349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUADALUPE AVILA M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	30W320 POMEROY ST
Second Line	:
City	:	WEST CHICAGO
State	:	IL
Zip	:	60185-3280
Country	:	US
Telephone Number	:	708-897-7599
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 E FOREST AVE
Second Line	:
City	:	WEST CHICAGO
State	:	IL
Zip	:	60185-3528
Country	:	US
Telephone Number	:	630-293-6000
Fax Number	:	630-596-2924

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

Provider Enumeration Date	:	05/11/2021
Last Update Date	:	05/11/2021

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Directions to “ GUADALUPE AVILA M.S. CCC-SLP” Practice Location

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