Provider Demographics
NPI:1316143688
Name:PEREZ, ANA LAURA (SPEECH LANGUAGE PATH)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:LAURA
Last Name:PEREZ
Suffix:
Gender:F
Credentials:SPEECH LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 E PALMER AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60164-1842
Mailing Address - Country:US
Mailing Address - Phone:847-903-7058
Mailing Address - Fax:
Practice Address - Street 1:346 E PALMER AVE
Practice Address - Street 2:
Practice Address - City:NORTHLAKE
Practice Address - State:IL
Practice Address - Zip Code:60164-1842
Practice Address - Country:US
Practice Address - Phone:847-903-7058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist