Provider Demographics
NPI:1700764792
Name:ANAYA, MARVIN (HIS)
Entity type:Individual
Prefix:
First Name:MARVIN
Middle Name:
Last Name:ANAYA
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 N CASS AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-2388
Mailing Address - Country:US
Mailing Address - Phone:630-968-4327
Mailing Address - Fax:
Practice Address - Street 1:47 6TH AVE STE I
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-5636
Practice Address - Country:US
Practice Address - Phone:630-968-4327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3628237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist