Provider Demographics
NPI:1518383967
Name:MATOS DESAUTELS, ADRIANA E (MHS, SLP-CF)
Entity Type:Individual
Prefix:MRS
First Name:ADRIANA
Middle Name:E
Last Name:MATOS DESAUTELS
Suffix:
Gender:F
Credentials:MHS, SLP-CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10935 S HALSTED ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-3127
Mailing Address - Country:US
Mailing Address - Phone:708-928-2000
Mailing Address - Fax:773-840-3504
Practice Address - Street 1:10935 S HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-3127
Practice Address - Country:US
Practice Address - Phone:708-928-2000
Practice Address - Fax:773-840-3504
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.002633235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist