Provider Demographics
NPI:1538686589
Name:HOEKSTRA, GLORIA (SLP)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:HOEKSTRA
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 1:16536 MAPLE CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-2254
Mailing Address - Country:US
Mailing Address - Phone:708-738-2309
Mailing Address - Fax:
Practice Address - Street 1:17101 S PARK AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-3484
Practice Address - Country:US
Practice Address - Phone:708-225-4755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146009050235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist