Provider Demographics
NPI:1730556226
Name:ANESTON, AMY (MHS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:ANESTON
Suffix:
Gender:F
Credentials:MHS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12641 W QUAILS ROOST DR
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-3753
Mailing Address - Country:US
Mailing Address - Phone:708-374-9167
Mailing Address - Fax:
Practice Address - Street 1:1864 HIGH GROVE LN STE 122
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-9213
Practice Address - Country:US
Practice Address - Phone:708-478-1820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.012312235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist