Most Relevant Information
Provider Data
| NPI Number: | 1003674375 |
| Provider Name: | IVALIS ANITA GUAJARDO MS SLP |
| Entity Type: | Individual |
| Taxonomy Code: | 235Z00000X |
| Specialty: | Speech-Language Pathologist |
| License Number: | 242.007250 |
Most Important Dates
| Enumeration Date: | 03/11/2024 |
| Last Updated: | 03/11/2024 |
Provider Practice Location
1075 E VICTORY DR
LINDENHURST
IL
600467910
Practice Location Phone/Fax
| Phone: | 8473564600 |
| Fax: |
Provider Mailing Location
1210 S WHITE OAK DR APT 934
WAUKEGAN
IL
600858353
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |