Provider Demographics
NPI:1497287908
Name:MENDOZA VIRGEN, IVONNE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:IVONNE
Middle Name:
Last Name:MENDOZA VIRGEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60064-2838
Mailing Address - Country:US
Mailing Address - Phone:630-297-7588
Mailing Address - Fax:
Practice Address - Street 1:2100 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-2838
Practice Address - Country:US
Practice Address - Phone:630-297-7588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-03
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist