Provider Demographics
NPI:1073076691
Name:KAVEN, MALVINA
Entity Type:Individual
Prefix:
First Name:MALVINA
Middle Name:
Last Name:KAVEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4551 OAKTON ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-3117
Mailing Address - Country:US
Mailing Address - Phone:847-679-4626
Mailing Address - Fax:847-679-4632
Practice Address - Street 1:4551 OAKTON ST
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-3117
Practice Address - Country:US
Practice Address - Phone:847-679-4626
Practice Address - Fax:847-679-4632
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2070237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363838770001Medicaid