Provider Demographics
NPI:1982852257
Name:VILGRE LA MADRID, ANNA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:VILGRE LA MADRID
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6314 N LAKEWOOD AVE
Mailing Address - Street 2:#1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-1440
Mailing Address - Country:US
Mailing Address - Phone:251-554-4865
Mailing Address - Fax:
Practice Address - Street 1:6314 N LAKEWOOD AVE
Practice Address - Street 2:#1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-1440
Practice Address - Country:US
Practice Address - Phone:251-554-4865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146008705235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist