Provider Demographics
NPI:1053667717
Name:CHANDANI, HEERA (MA-CCC SLP/L)
Entity Type:Individual
Prefix:MS
First Name:HEERA
Middle Name:
Last Name:CHANDANI
Suffix:
Gender:F
Credentials:MA-CCC SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 N LAKE SHORE DR
Mailing Address - Street 2:29E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4810
Mailing Address - Country:US
Mailing Address - Phone:847-877-0118
Mailing Address - Fax:
Practice Address - Street 1:3150 N LAKE SHORE DR
Practice Address - Street 2:29E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4810
Practice Address - Country:US
Practice Address - Phone:847-877-0118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146009387235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist