Basic Information
| Provider Information | |||||||||
| NPI: | 1881963890 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REYES | ||||||||
| FirstName: | LOURDES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5311 S KILPATRICK AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606324932 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2425 E 71ST ST | ||||||||
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| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606492612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737215000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2011 | ||||||||
| LastUpdateDate: | 12/20/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 146009519 | IL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.